Surgery gives the best chance of curing primary liver cancer. There are different types of surgery for early liver cancer. These are:
- removal of part of the liver (liver resection or lobectomy)
- liver transplant
Who can have surgery for primary liver cancer?
Your specialist will only consider surgery if the cancer is contained in one area of your liver and has not spread to any other part of your body. This generally means stage 0 or stage A from the BCLC staging system. An operation would not cure the cancer if it has already spread. Unfortunately surgery is not possible for many people with primary liver cancer.
You have a series of blood tests to find out how well your liver is working before your doctor decides if surgery is an option for you. As the liver is such a vital organ, they 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 your liver is known as a resection. Your surgeon is only likely to consider a resection if:
- the cancer is small
- your liver is healthy
- the cancer hasn’t grown into the blood vessels
Your surgeon might remove a lobe of your liver. This is called a lobectomy or hemi hepatectomy. The liver can grow back and work normally if you don’t have any underlying problems, such as cirrhosis.
A type of liver cancer called fibrolamellar cancer is more likely to develop in people without liver disease, which means that surgery is often possible.
Unfortunately there is a risk that the cancer could come back after a liver resection. There's 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's less chance of spread.
If you have cirrhosis, you might 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 liver transplant if possible.
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 3 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. Unfortunately, you might have to wait a long time for a liver to become available and in this time the tumour might grow. Waiting for a liver transplant can be stressful for you and your family. Your doctor might consider other treatments in the meantime, such as ablation or chemoembolisation.
Unfortunately, if you have very severe cirrhosis you are not likely to be fit enough to have this major surgery. A specialist transplant surgeon will look at all your test results and decide whether you are likely to make a good recovery from the surgery.