Removing the tumor is the only way to cure liver cancer. Taking the whole tumor out will give you the best chance of survival. However, it can be hard to remove the whole tumor, even if it has not spread beyond the liver. Surgery may not be an option for people with cirrhosis who do not have enough healthy liver tissue remaining. Surgery is not an option if the cancer has spread past the liver to other parts of the body.
For people who are not eligible for surgery (liver resection or transplant), other techniques may be used to try to destroy liver tumors.
If the tumor can be removed, it is most often done during an operation called a liver resection or a partial hepatectomy. This can be done by open surgery or laparoscopy.
A liver resection is a major operation that can have serious side effects. After surgery, you may have pain in the area where the surgery was performed. This is normal and should not last long. Usually patients with liver cancer also have cirrhosis of the liver that can complicate surgery. Your surgeon will discuss with you these and other risks of the surgery. Some of the most common other risks are:
Bleeding during or after surgery that may require blood transfusions
Damage to the liver and blood vessels during surgery
A liver transplant is the best option for liver cancer. It is an option for people with liver cancer who have a few small tumors that can be totally removed with the liver transplant, and sometimes for patients with liver cirrhosis with more advanced disease who cannot otherwise undergo tumor resection. A transplant is best if you are otherwise in good health and have no tumor outside your liver. Unfortunately, there is a shortage of livers. There are also side effects to both the surgery and the antirejection drugs you need after a transplant. Plus, the tumor may return after a transplant. These problems make liver transplant a limited option.
The possible side effects from a liver transplant are similar to those for a liver resection and can be serious. People who get a liver transplant must also take medicines to lower the risk that the body will reject the new organ. These medicines can weaken the immune system, raising a person's risk for serious infections. They may have other side effects as well.
Energy can destroy a liver tumor without removing it. This is called ablation. This procedure may be recommended for patients with only a few small tumors that cannot be removed with surgery. One type of ablation is RFA (radiofrequency ablation). This treatment uses a heated probe inside the tumor to kill it. You may have RFA done at the same time as surgery. Your surgeon places a scope through a small cut in your abdomen. This is called laparoscopic ablation. Or the surgeon may pass the probe through your skin. This is called percutaneous ablation.
Another option is to inject highly concentrated alcohol or acetic acid into the tumor to kill the cancer cells. This is called ethanol or acetic acid ablation. Because only small amounts of ethanol can be used, this treatment works best for small liver tumors. For this procedure, the doctor inserts a needle through the skin and injects ethanol into the tumor. This is called percutaneous ethanol ablation. RFA ablation has become more commonly done than ethanol or acetic acid ablation.
A third option in some cases is cryoablation or cryotherapy. For this technique, very cold gases are passed through a metal probe inserted into the tumor. It can sometimes be used to treat slightly larger tumors.
Because ablation does not kill healthy liver cells, it may be a good treatment for people with many smaller liver tumors. It may also be a good choice for people with hepatitis, cirrhosis, and other liver problems. Although these procedures can destroy more than one liver tumor, they are best for people with small tumors.
Serious side effects from ablation are rare, but may include pain, bleeding, and infection in the liver.
The goal of embolization is to block the blood supply to liver cancers. The radiologist puts a catheter in your groin and uses X-ray guidance to thread a catheter (a long, thin, hollow tube) into your hepatic artery. Then he or she injects special particles, coils, or oils with or without chemotherapy or radiation into some branches of this artery to stop blood flow to the tumor, which helps slow or block its growth. Sometimes the embolization materials are coated with chemotherapy (bead chemoembolization) or with radioactive substances (radioembolization) to try to kill nearby cancer cells.
Side effects from embolization are usually not serious, but can include pain, fever, infection, and blood clots in the liver and systemic effects of chemotherapy.