Treatment options for liver cancer

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

• where your cancer is

• the size of the cancer and whether it has spread (the stage)

• the type of liver cancer

• how well your liver is working

• your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments for cancer that started in the liver (primary liver cancer) are:

• surgery
• chemotherapy directly into the liver and cutting off the blood supply to the tumour (chemoembolisation or TACE)
• heat directly to the tumour (thermal ablation) - radiofrequency ablation (RFA) or microwave ablation (MWA)
• targeted cancer drugs, such as atezolizumab and bevacizumab
• radiotherapy

Surgery

Unfortunately surgery isn't possible for many people with liver cancer. If you have early liver cancer, you will have tests to see if surgery might be an option. 

There are 2 types of surgery for primary liver cancer:

• an operation to remove part of the liver (liver resection)
• a liver transplant

Liver resection

A liver resection might be an option if your cancer is only in your liver and the rest of your liver is healthy. You are more likely to have this type of surgery if you don't have cirrhosis (scarring of the liver due to previous damage).  A surgeon can remove a small area, or up to three quarters of a liver. The liver is able to recover and regrow. Your surgeon will explain what is possible in your situation.

A type of liver cancer called fibrolamellar hepatocellular cancer develops more often in people who do not have cirrhosis. So it is often possible to remove these cancers with surgery.

Liver transplant

People who have cirrhosis usually can't have a liver resection because the rest of the liver isn't healthy enough. But in some situations, your specialist may suggest a liver transplant if you have cirrhosis of the liver and you have: 

• a single tumour no more than 5cm across
• a single tumour that is 5 to 7cm across and has not grown for at least 6 months
• no more than 5 small tumours, each no larger than 3cm across 

Finding a donor is difficult and can take months. You may need other treatments while you are waiting for the transplant to control the growth of the cancer.

Severe cirrhosis of the liver can mean you aren't fit enough for a transplant. Your team will discuss the best treatment options for your individual situation.

If you can't have surgery

Surgery may not be possible because:

• the tumour is too large
• the tumour is in a part of the liver that makes it hard to remove, such as being near a blood vessel
• you have several tumours spread through the liver
• you aren't well enough for surgery
• your cancer has spread to other parts of the body

You might have local treatments to the liver including:

• chemoembolisation (TACE)
• radiofrequency ablation (RFA) or microwave ablation (MWA)
• percutaneous ethanol injection (PEI) - for tumours less than 2cm

You might also have: 

• targeted cancer drugs such as atezolizumab and bevacizumab
• external radiotherapy
• stereotactic body radiotherapy (SBRT)
• selective internal radiation therapy (SIRT)

Advanced liver cancer

Advanced liver cancer means that the cancer has spread beyond the liver to other parts of your body. Treatment aims to help you live longer and to maintain a good quality of life by controlling the growth of your cancer and treating symptoms. 

You might have: 

• targeted cancer drugs such as atezolizumab and bevacizumab
• radiotherapy, usually to areas of the body where the cancer has spread 

Or your doctor will offer treatments to help control your symptoms. These symptoms can include pain, weight loss, shortness of breath, jaundice. Sometimes people with liver cancer and cirrhosis may get a build up of fluid in the abdomen (ascites).

Tell your doctor and nurses about any symptoms you have so they can treat them. They can also refer you to a symptom control team (palliative care team) to help manage your symptoms.

Your choices

Your doctor might offer you a choice of treatments. They will discuss the advantages and disadvantages of each with you. You can ask how these treatments might control any side effects. This helps you make the right decision for you.

You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might need to make further choices as your situation changes. It helps to find out as much as possible each time.

You can stop your treatment whenever you want to if you find them too much to cope with.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Second opinion

Some people might want to get a second opinion before starting treatment. You can ask your specialist or GP to refer you to a doctor or surgeon specialising in liver cancer. It can be better to arrange a second opinion through your specialist because they can send all your notes and test results with you.

Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which they feel is the best treatment for you. 

It can take time to arrange a second opinion, which might mean that your treatment is delayed for a while. Remember also that several specialists will be involved in your care as part of your multi disciplinary team. Between them, they discuss the best way to treat your cancer.