How Liver Cancer Is Treated

A look at surgery, liver transplant, and prescription drugs

The treatment of liver cancer depends on the stage of the cancer, as well as a person's underlying liver function.

While the preferred treatment is surgical removal of the cancer, many people are not candidates for surgery due to the extent of their disease and/or poor baseline liver health. Besides surgery, other treatment options include liver transplant, ablation therapy, embolization therapy, and prescription medications like targeted therapy, chemotherapy, and immunotherapy.

Surgery

Surgical removal of liver cancer is the treatment of choice. The challenge with surgery, however, is that most people with liver cancer also have cirrhosis from long-term liver disease.

With limited liver function from cirrhosis (the liver is so scarred), removing even a small part of liver tissue along with the cancer may render a liver functionally inadequate. Moreover, many liver cancers cannot be properly removed because they are too large and/or have spread outside the liver.

Evaluation

In order to access whether or not a person is a good surgical candidate, a doctor will order an imaging test (like a CT scan or MRI) to evaluate the extent of the cancer, as well as liver function blood tests. The best surgical candidate is someone with a single liver tumor (not multiple) and preserved liver function.

If you or a loved one is undergoing liver cancer surgery, it's imperative you review all the risks and possible side effects with your surgeon. In addition, do not be afraid to ask questions and inquire about your surgeon's experience.

Possible Side Effects

Surgical removal of liver cancer is a major surgery, especially since the liver is rich in blood vessels. This makes bleeding during surgery a major concern.

Other potential side effects of surgery include:

Your medical team will monitor you in order to minimize these risks, and provide instructions for ways you can minimize risk of complications as well.

Liver Transplant

Besides surgery, undergoing a liver transplant is another potentially curable treatment option, with the added benefit of treating not only the cancer but the cirrhosis, too. During a liver transplant, a transplant surgeon removes the diseased liver and replaces it with a healthy one from another person.

A doctor may recommend a liver transplant if a liver tumor(s) is small or if surgery is not a possibility due to an unhealthy liver.

A major obstacle with liver transplants is the limited availability of livers. According to the American Cancer Society, only about 6,500 livers are available for transplant each year, and most of them are used for people with liver problems other than cancer.

Possible Side Effects

In addition to the possible side effects associated with liver surgery (bleeding, infection, blood clots, anesthesia complications, and pneumonia), there are potential side effects linked to the medications a person needs to take after the transplant.

These immune-suppressing medications prevent a person from rejecting their new liver. Because they suppress your immune system, though, people are prone to infections.

Other potential side effects of immune-suppressing drugs include:

  • High blood pressure
  • High cholesterol
  • Kidney problems
  • Diabetes
  • Bone weakening (called osteoporosis)

Non-Surgical Procedures

For people with liver cancer who are not surgical candidates, ablation and/or embolization therapy may be a treatment option. These therapies shrink and possibly destroy liver tumors. 

Ablation Therapy

Ablation therapy is a non-surgical means of killing cancer cells and is the most frequently utilized therapy in liver cancer care. This procedure entails placing a needle or probe directly into a liver tumor and using various means to kill the cells.

The types of ablation therapy are named based on the means used to destroy the cancer cells:

  • Radiofrequency ablation (RFA): High-energy radio waves heat and kill the cancer cells
  • Percutaneous ethanol (alcohol) ablation: Alcohol is injected into the cancer cells
  • Cryotherapy: Very cold gases are passed through the tumor to freeze the cancer cells
  • Microwave ablation: Heat from microwaves is transmitted into the cancer cells

As with any procedure, there are risks and potential side effects to undergoing ablation. Some of these include:

  • Bleeding and bruising at the skin site where the needle or probe is inserted
  • Damage to blood vessels in the liver or the surrounding liver tissue if the needle or probe is improperly placed
  • Infection, including liver abscess
  • Damage to the bile duct or other organs
  • Tumor seeding (a rare complication in which cancer cells are dispersed along the tract of the needle)

Embolization Therapy

During embolization, the blood supply to the liver cancer is blocked off so the cancer is "starved" and cannot grow. This treatment option may be used for liver tumors that are large and/or cannot be removed surgically.

Sometimes embolization is combined with chemotherapy (called chemoembolization) or radiation (radioembolization).

Prescriptions

Prescription medications are used to treat advanced or late-stage liver cancer.

Targeted therapies are first-line therapy for treating advanced liver cancer, followed by chemotherapy or immunotherapy as a second-line option.

Targeted Therapies

Targeted drugs work by interfering with substances needed for cancer to grow. An approved first-line therapy for treating un-resectable liver cancer (meaning liver cancer that cannot be removed surgically) is Nexavar (sorafenib), which is a targeted drug that blocks a liver tumor from making new blood vessels.

Common side effects of Nexavar include:

  • Fatigue
  • Rash
  • Loss of appetite
  • Diarrhea
  • High blood pressure
  • Hand-foot reaction

For people who cannot tolerate Nexavar, or as an alternative first-line therapy, a similar drug called Lenvima (lenvatinib) may be considered.

In a phase III study, Lenvima (when compared to Nexavar) had a higher overall survival benefit (13.6 months versus 12.3), higher response rate (24 percent versus 9 percent), and a higher time to disease progression (7.4 months versus 3.7 months).

The most common side effects of Lenvima are:

  • High blood pressure
  • Diarrhea
  • Decreased appetite
  • Weight loss
  • Fatigue

Another targeted drug Stivarga (regorafenib) blocks proteins that help liver cancer cells grow. This drug is currently used as a second-line therapy (meaning if Nexavar or Lenvima stop working).

Common side effects include:

  • Fatigue
  • Loss of appetite and weight loss
  • Rash on hands and feet
  • High blood pressure
  • Fever and infections
  • Diarrhea
  • Belly pain

Chemotherapy

Chemotherapies are drugs that kill cancer cells. While "chemo" is generally taken by mouth or through a vein, in the case of liver cancer, it may be administered directly into the liver through the hepatic artery (called hepatic artery infusion).

Depending on the type and dose of chemotherapy given, a person may experience a range of possible side effects like:

  • Loss of hair
  • Mouth sores
  • Nausea, vomiting, and/or diarrhea
  • Weight loss from a decrease in appetite

Since chemo drugs target rapidly dividing cells (cancer cells grow quickly), cells in a person's bone marrow are often destroyed. This may lead to symptoms like easy bruising and bleeding, as well as fatigue and a high risk of infection.

Immunotherapy

Immunotherapy is a very exciting, evolving treatment option that has changed the face of cancer care. The premise behind immunotherapy is that it stimulates a person's own immune system to attack cancer cells.

For liver cancer, the immunotherapy drug Opdivo (nivolumab) works by blocking an immune checkpoint protein called programmed death 1 (PD-1). This protein is deceitfully made by cancer cells to prevent a person's immune system from recognizing it as foreign. So, by blocking PD-1, cancer can then be recognized and attacked.

Opdivo is given through the vein, every two weeks. Potential side effects include:

  • Fatigue or weakness
  • Fever
  • Cough
  • Nausea and loss of appetite
  • Itching and skin rash
  • Muscle or joint pain
  • Constipation or diarrhea

More serious side effects include a reaction to the infusion (similar to an allergic reaction) or an autoimmune reaction, in which a person's own immune system begins attacking healthy organs (for example, the lungs).

Complementary Medicine

Before using any herb or food, be sure to let your doctor know. This will help prevent any unwanted side effects and interactions.

Sho-saiko-to

One herbal drug called Sho-saiko-to (also called Xiao Chai Hu Tang), which is a mixture of seven botanicals, including ginseng, ginger, and licorice, has been used to treat chronic hepatitis and cirrhosis.

Some research suggests that this herbal drug may also help suppress the development of liver cancer in people with cirrhosis, although its precise mechanism of action is unclear. While Sho-saiko-to is believed to be generally well-tolerated, it can cause lung and liver injury, so should only be taken under the guidance of a doctor.

Holy Basil

Another herb called Ocimum sanctum L or "Holy Basil" is a plant that contains phytochemicals that promote liver health. It also possesses anti-cancer properties. This green vegetable is sometimes used in Thai cuisines. It has no known side effects.

Milk Thistle

Silymarin (Silybum marianum), also called milk thistle, is used in some countries (like Germany) as a supportive treatment for chronic liver disease. It's also believed to have anti-cancer properties and has a good safety profile, although it may cause an allergic reaction or mild digestive symptoms.

Natural Foods

Besides herbs, natural foods may also help protect against liver cancer. Coffee is a rich source of antioxidants and is linked to a reduced risk of both cirrhosis and liver cancer. However, there is no scientific evidence that increasing your current coffee consumption (or starting to drink coffee if you never have) is beneficial.

Another natural food, resveratrol, which is found in mulberries, red grapes, and peanuts, may have anti-cancer effects in addition to protecting against non-alcoholic fatty liver disease.

What You Can Do to Prevent Liver Cancer
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