Surgery is the main treatment for primary liver cancer. Find out about the types of surgery for liver cancer.
Who can have surgery for primary liver cancer
Your specialist will only consider surgery if the cancer is contained in one area of the liver and has not spread to any other part of the body. This is because the surgery will not cure the cancer if it has already spread. Unfortunately surgery is not possible for many people with primary liver cancer.
You will have a series of blood tests to find out how well your liver is working before they decide if surgery is an option for you. As the liver is such a vital organ, your doctors need to know that the part of your liver left after your operation will work well enough to keep you healthy.
Liver resection and lobectomy
Removing the cancer and the surrounding tissues in the liver is known as a resection. Your surgeon is only likely to consider doing a resection if the cancer is small and there are no major blood vessels involved.
Sometimes they remove a lobe of the liver. This is called a lobectomy or hemi hepatectomy. The liver can grow back and work normally if you've no underlying medical problems with your liver (such as cirrhosis).
Fibrolamellar cancer is more likely to develop in people with no other liver disease and so surgery is often possible.
Recovering after surgery
There is a risk that the cancer could come back after a liver resection. There is no test that can guarantee that cancer cells haven't broken away from the tumour before it is removed. That's why this type of treatment is only used for small liver tumours - where there is less chance of spread.
If you have cirrhosis, you may not have enough healthy liver for your body to cope with removing part of it. Liver failure after a resection or lobectomy is much more likely in people who have cirrhosis. So your specialist may be more likely to consider a transplant if surgery is possible.
Radiofrequency ablation (RFA)
Radiofrequency ablation uses heat made by radio waves to kill cancer cells. Your doctor puts a probe into the tumour and the electrical current kills the cancer cells.
You might have this treatment if you have several small tumours in the liver that can't all be removed with surgery, you have RFA to treat the remaining few tumours.
A liver transplant
A liver transplant is possible in some people with hepatocellular liver cancer (HCC). You might be able to have a liver transplant if you have:
- no more than 5 small tumours in your liver, each 3cm across or less
- a single liver tumour no more than 5 cm across
- a single tumour that is 5 to 7 cm across that has not grown (either with or without treatment) for at least 6 months
To have a liver transplant you need a donor liver that is a close match to yours. You may have to wait a long time.
Early primary liver cancer
For early primary liver cancer, a liver transplant can be a good treatment option. A liver transplant will not be an option if the tumours in your liver are too big. You might be able to have other procedures, such as radiofrequency ablation or chemoembolisation, to shrink the tumours. Once the tumours are small enough, a liver transplant might be possible.
You can usually have a transplant if you have cirrhosis. In fact, this is the main reason for using liver transplants in liver cancer. It is a better option in these situations than resection because you have liver disease in general. However, you may not be able to have a liver transplant if you have severe cirrhosis.
Your liver specialist has to be sure that you are well enough to get through the operation and recovery period. These risks are higher if you have very severe cirrhosis.
Some people who have liver cirrhosis, but have good liver function, may be able to have a liver resection if a transplant is not possible for any reason. You might be able to have a resection if you have an early cancer that has not grown too large within the liver.
When the cancer has spread
A liver transplant is not an option when the cancer has spread out of the liver. Cancer cells elsewhere in the body would be left behind even if the liver was removed. So the surgery would not cure the cancer.
What to do next
Talk to your specialist about these issues so you can both come to a decision about the best course of action.