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 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.
The main treatments for cancer that started in the liver (primary liver cancer) are:
- chemotherapy directly into the liver and cutting off the blood supply to the tumour (chemoembolisation or TACE)
- heat directly to the tumour (tumour ablation) - radiofrequency ablation (RFA) or microwave ablation (MWA)
- targeted cancer drugs, such as sorafenib
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
A liver resection might be an option if your cancer is only in your liver and the rest of your liver is healthy. Your surgeon can remove anything from a small wedge to up to 80% of your liver. 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 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.
People who have cirrhosis usually can't have a liver resection because the rest of the liver isn't healthy enough. So, your specialist may suggest a liver transplant if you have cirrhosis of the liver and you have:
- a single liver tumour that is 5cm across or less
- up to 3 tumours that are all 3cm across or less
- a single tumour 5 to 7cm in size that has not grown for at least 6 months
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. Assessing your fitness will be part of the process of deciding whether you can have the operation. It is a very big operation and if you are already ill you may not survive it.
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
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 sorafenib
- stereotactic body radiotherapy (SBRT)
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:
- a targeted cancer drug such as sorafenib
- radiotherapy, usually to areas of the body where the cancer has spread to
Or your doctor will offer other treatments to help control your symptoms rather than control the cancer itself. 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 doctor might offer you a choice of treatments. Discuss the advantages and disadvantages of each treatment with them and ask how they can 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’ll 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.
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.
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.