Liver Cancer: Treatment Options

How is it treated?

There are many different treatment options for patients diagnosed with liver cancer. Many factors play a role in determining the most suitable option. These factors include the extent, origin, stage, and location of the cancer, as well as the general health of the patient. Below, many of the possible treatment options are described. It is important that you speak with your doctor about your particular treatment plan, as each person's treatment will be individualized.

• Treatment Liver Cancer with Surgery: If the placement and number of the tumors is such that the cancer can be treated by removed the affected area, there are two surgical options.
  
  • Surgical Resection (Partial hepatectomy) - Patients with few tumors and an otherwise healthy liver may be eligible for a partial hepatectomy. In this procedure, the surgeon will remove the section of the liver that contains the tumors. The liver that remains in the body will take over the function of the removed sections.
    
    
  • Liver Transplant (Total hepatectomy) - In rare cases where the cancer has not spread from the liver, but tumor position makes a partial hepatectomy impossible, the patient may be a candidate for a liver transplant. Patients needing a liver transplant will need to wait until a donor liver is available. Once a donor is found to be a close biological match to the patient, the patient's liver is removed and is replaced with the donor liver.
    
    
• Treating Tumors without Surgery: Sometimes tumors are located in areas that are unreachable by surgery, or a patient may not be strong enough for the body to handle surgery. In these cases, the tumors of liver cancer may be treated without performing surgery.
  
  • Radiofrequency ablation (RFA) - In this procedure, a thin needle is inserted into the tumor. The needle then emits heat, killing the cancer cells.
    
    
  • Ethanol (Alcohol) ablation - Ethanol ablation, like RFA, requires the injection of a small needle into the tumor. In ethanol ablation, alcohol is injected into the tumor to kill cancer cells. This procedure may need to be done once or twice a week until the tumor has shrunk.
    
    
  • Cryosurgery - Cryosurgery is similar to both RFA and ethanol ablation. During cryosurgery, the probe inserted into the tumor freezes the cancer cells. General anesthesia is used more often in Cryosurgery than in the above methods. When general anesthesia is used, the patient is put to sleep.
    
    
  • Hepatic arterial infusion - This procedure limits the blood supply to the tumor. A catheter is inserted into the vein through the upper leg, it is then guided to the tumor and an injection will block the blood supply.
    
    
  • Chemoemoblization - Chemoemoblization is similar to hepatic arterial infusion, only in this procedure cancer killing drugs are inserted into the artery along with the blocking substance.
    
    
• Treatment when cancer has spread to other areas of the body: More advanced cancers often spread to affect other (secondary) locations in the body (metastasis). If liver cancer spreads, treating the liver alone will not treat the disease. When cancer spreads, systemic or whole body treatments are necessary.
  
  • Chemotherapy - Chemotherapy is the use of drugs to kill cancer cells. These drugs can be delivered either orally, or in the form of pills, or intravenously, directly into the blood stream though a needle placed into the blood vessel. In chemotherapy, combinations of drugs tend to be more effective than just one type of drug by itself.
    
    Chemotherapy drugs can usually be taken in a doctor's office or hospital, or even at home in some cases. Usually, the patient will go to see the doctor every day for a few weeks to receive the treatment. The patient will then have some time off from the medicine in order to build up strength and allow his or her immune system to recover. This cycle can continue until the doctor determines the cancer has stopped spreading or is beginning to go away.
    
    The dose, or amount of chemotherapy you receive depends on several factors, including your medical history, age, and severity of cancer. Studies have found that younger patients are better able to handle the side effects of higher doses of these drugs. Patients who have experience chemotherapy in the past or those whose bodies are no longer responding to the treatment may not feel the benefits as strongly as other.
    
    
  • Radiation - In this form of treatment, high-energy rays are targeted at the tumor area. A doctor can apply radiation locally to the tumor site in an attempt to reduce the size of the tumor and prevent any further growth. The patient usually needs to go to a radiation oncology department five days a week for several weeks in order to have this procedure done.
    

Possible Side Effects From Treatments

• Surgical Treatments - When a surgery is performed, the patient can expect to experience some general discomfort during the first few days of recovery. Also, pain may be felt at the site of the surgeon's incision. The more complication the surgery, the greater recovery time that will be needed. Recovering from surgery will differ from one patient to the next. Ease and speed of recovery is heavily dependent on the patient's age, general health, and the nature of the surgery. Your doctor will be able to give you a better idea of what to expect following a particular procedure.
  
  
• Radiofrequency ablation (RFA) - During RFA, either local or general anesthesia is used. Patients using general anesthesia can expect some grogginess or fatigue immediately following the procedure. Patients may experience some pain or soreness at the site of the injection during recovery.
  
  
• Ethanol (Alcohol) ablation - The side effects experienced during an ethanol ablation are similar to those described in RFA (see above). In all cases, the side effects may vary by patient and depend upon the exact nature of the procedure.
  
  
• Cryosurgery - The side effects of cryosurgery are similar to those of the above methods. If general anesthesia is used (which is common for this procedure), the patient may not be permitted to drive for 24 hours following the procedure.
  
  
• Hepatic arterial infusion - Limiting the blood supply to the liver, as done by this procedure, is not recommended for hepatitis or cirrhosis patients. Only a healthy liver can function with a limited blood supply.
  
  
• Chemoembolization - The side effects of this procedure are similar to those of hepatic arterial infusion. Also, in chemoemobolization the patient may experience a reaction to the drugs being injected (see chemotherapy below).
  
  
• Chemotherapy - The medicine used in chemotherapy targets and kills the cancer cells in the body. Cancer cells are identified by the medicine as those cells that divide rapidly. Many times chemotherapy not only kills these cancer cells, but it can damage or even reduce the number of normal, healthy cells in the body, in particular, those health cells which divide rapidly. These cells include:
  
  • The lining of the digestive tract, including the inside of the mouth and the cells in the intestines.
    
  • The immune cells located in the bone marrow.
    
  • The cells responsible for hair growth on various parts of the body (hair follicles).
    
  
  As a result, a chemotherapy patient may experience some side effects such as sores inside the mouth, digestive problems such as loss of appetite or nausea and vomiting. Patients also tend to experience hair loss as a result of chemotherapy. The immune system also suffers because the body is less able to fight off infection and produce blood cells. A lack of red blood cells may also result in fatigue and a decrease in platelets may result in bruising easily and prolonged bleeding. These side effects are, for the most part, temporary and will go away when the chemotherapy is stopped. Some of the permanent side effects include early menopause in women and infertility in both men and women.
  
  
• Radiation - Patients undergoing radiation therapy often complain of feeling tired. The radiation exposure can also cause a patient's skin to become red and dry, especially in the areas that are exposed to the cold air or sun, or where clothing may rub. You should avoid using any creams or lotions unless your doctor prescribes them. Wearing loose, soft, comfortable clothing and avoiding extreme hot or cold temperatures can help with this. Also, the radiation can affect various parts of the body, depending on the location of the tumor. For instance, in the case of liver cancer, the digestive system is exposed to radiation because of the tumor's location. This may cause the patient to experience some digestive problems or nausea and/or vomiting.
  

Follow Ups

Throughout your treatment process, and even afterwards, it is important to keep your doctor up to date on how you are doing. If your doctor suggests follow-up visits, be sure to go to the appointments. If further tests are ordered, it is important that you have them done. Even though you may be feeling better, you want to make sure that you are able to stay healthy over time. Your doctor is there to help you, and he or she is one of your best resources for information and support throughout this process.

Certain lifestyle and dietary habits may reduce your risk of many types of cancers. Some of these include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat diet
  

In preventing liver cancer in particular, it is important to limit alcohol consumption, and prevent the spread of Hepatitis.

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