Adult Primary Liver Cancer : Treatment Options

by National Cancer Institute

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There are different types of treatment for patients with adult primary liver cancer.

Different types of treatments are available for patients with adult primary liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery

The following types of surgery may be used to treat liver cancer:

Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ (cancer that involves only the cells in which it began and that has not spread to nearby tissues). This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.

Partial hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.

Total hepatectomy and liver transplant: Removal of the entire liver and replacement with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.

Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. Radiation therapy is given in different ways:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.

• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

• Drugs called radiosensitizers may be given with the radiation therapy to make the cancer cells more sensitive to radiation therapy.

• Radiation may be delivered to the tumor using radiolabeled antibodies. Radioactive substances are attached to antibodies made in the laboratory. These antibodies, which target tumor cells, are injected into the body and the tumor cells are killed by the radioactive substance.

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Regional chemotherapy is usually used to treat liver cancer. A small pump containing anticancer drugs may be placed in the body. The pump puts the drugs directly into the blood vessels that go to the tumor.

Another type of regional chemotherapy is chemoembolization of the hepatic artery. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Percutaneous ethanol injection

Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. The procedure may be done once or twice a week. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be needed.

Other types of treatment are being tested in clinical trials. These include the following:

Hyperthermia therapy

Hyperthermia therapy is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumor shrinks.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Adult Primary Liver Cancer

Localized Resectable Adult Primary Liver Cancer

Treatment of localized resectable adult primary liver cancer may include the following:

• Surgery (partial hepatectomy).
• Surgery (total hepatectomy) and liver transplant.
• A clinical trial of regional or systemic chemotherapy or biologic therapy following surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Localized and Locally Advanced Unresectable Adult Primary Liver Cancer

Treatment of localized and locally advanced unresectable adult primary liver cancer may include the following:

• Surgery (cryosurgery or radiofrequency ablation).
• Chemotherapy (chemoembolization, regional chemotherapy, or systemic chemotherapy)
• Percutaneous ethanol injection.
• Surgery (total hepatectomy) and liver transplant.
• Radiation therapy with radiosensitizers.
• A clinical trial of a combination of surgery, chemotherapy, and radiation therapy. Hyperthermia therapy may also be used. Chemotherapy and radiation therapy may be used to shrink the tumor before surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Advanced Adult Primary Liver Cancer

There is no standard treatment for advanced adult primary liver cancer. Patients may consider taking part in a clinical trial. Treatment may be a clinical trial of biologic therapy, chemotherapy, and/or radiation therapy with or without radiosensitizers. These treatments may be given as palliative therapy to help relieve symptoms and improve the quality of life.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Recurrent Adult Primary Liver Cancer

Treatment of recurrent adult primary liver cancer may include the following:

• Surgery (partial hepatectomy).
• Surgery (total hepatectomy) and liver transplant.
• Chemotherapy (chemoembolization or systemic chemotherapy).
• Percutaneous ethanol injection.
• A clinical trial of a new therapy.

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