If you’ve received the news that you have hepatocellular carcinoma (HCC), you probably have many questions about treatment.
Read on to learn about the different types of treatment for liver cancer and how they work. Your doctor can explain why certain treatments may be better for you than others.
Among adults, HCC is the most common type of liver cancer. Risk factors for liver cancer include alcohol misuse, cirrhosis, and hepatitis B or C.
There are quite a few methods of treating HCC. Surgical resection and liver transplant are associated with the best survival rates.
As with most types of cancer, your treatment plan will likely involve a combination of several treatments. Your doctor will make recommendations based on:
- your age and general health
- the cancer stage at diagnosis
- the size, location, and number of tumors
- how well your liver is functioning
- whether or not this is a recurrence of previous liver cancer
There are different systems for staging HCC using roman numerals I to IV or letters A to D. Generally, early stages are operable.
This means it’s surgically possible to either remove the tumor and some surrounding tissue, or to replace the liver with a transplant.
In an unresectable case, cancer hasn’t spread to other parts of the body, but it’s not operable. This may be because the tumor is too big or in an awkward location.
Advanced, or metastatic, liver cancer has spread to other parts of the body like nearby organs, meaning it’s too widespread for surgery. Treatments include a variety of drugs, immunotherapy, and radiation.
Recurrent cancer means it’s come back after treatment, either near where it started or in other parts of the body. Treatment, potentially including more surgery, depends on factors like where the recurrence is and how well the liver is functioning.
Surgical resection involves removing the part of the liver that contains the tumor. This is a good option if:
- the rest of your liver is functioning well
- cancer hasn’t grown into blood vessels
- cancer hasn’t spread outside the liver
- you’re healthy enough for surgery
It may not be a good option if:
- your liver doesn’t function well, usually due to cirrhosis
- the cancer has metastasized
- you’re not healthy enough for surgery
Risks of surgery include infection, bleeding, and blood clots.
Targeted drugs are used to focus on the cells that are involved in the growth and development of cancer.
One type of targeted therapy for liver cancer is kinase inhibitors, such as sorafenib (Nexavar). This drug has two functions. It blocks tumors from forming new blood vessels, which tumors need to grow. It also targets certain proteins on cancer cells that fuel growth. Sorafenib is a pill you can take twice per day.
Regorafenib (Stivarga) works in a similar way. It’s usually the next step when sorafenib has stopped working. It’s a pill you take once per day.
High-powered X-ray energy, known as radiation therapy, is used to kill cancer cells and shrink tumors.
External beam radiation is usually given 5 days per week for several weeks. It can take some time to get you set up in exactly the right position before each treatment. The actual treatment only takes a few minutes, during which you’ll have to remain perfectly still.
Temporary side effects of radiation therapy include skin irritation and fatigue.
Another type of radiation therapy is called radioembolization. In this procedure, the doctor injects small radioactive beads into the hepatic artery.
The beads give off radiation for several days. This radiation is confined to the tumor in the liver, sparing surrounding tissue.
Immunotherapy is a type of medication that helps your immune system find and fight cancer. This can sometimes help treat liver cancer.
- ipilimumab (Yervoy)
- nivolumab (Opdivo)
- atezolizumab (Tecentriq)
- pembrolizumab (Keytruda)
These drugs are typically given intravenously, and they work by targeting specific proteins that cancer cells use to blend in and avoid being attacked by your immune system.
Side effects of immunotherapy can include fatigue, fever, cough, loss of appetite, and nausea.
Radiofrequency ablation is a procedure in which the surgeon uses an ultrasound or CT scan to guide a needle through the abdomen into the tumor. An electric current is used to heat and destroy cancer cells.
Cryoablation uses extreme cold to kill cancer cells. In this procedure, the doctor uses ultrasound to guide an instrument containing liquid nitrogen, which is injected directly into the tumor.
Pure alcohol can also be used to destroy cancer cells. Your doctor can inject it into the tumor through your abdomen or during surgery.
If you have early stage liver cancer but can’t have surgical resection, you may qualify for a liver transplant. This procedure significantly lowers the risk of a second, new liver cancer.
However, donor livers are in short supply and waiting lists are long.
If you do have a liver transplant, you’ll need antirejection medications for the rest of your life.
Transplant surgery risks include bleeding, blood clots, and infection.
Chemotherapy uses drugs to destroy cancer cells. The drugs can either be taken by mouth or through injection.
In the case of hepatic artery infusion (HAI), a pump and catheter are surgically inserted in order to deliver chemo drugs directly into the liver.
Chemo has not proven very effective against liver cancer, but it’s sometimes used in cases where surgery isn’t an option and other therapies aren’t helping.
Side effects of chemotherapy include hair loss, stomach problems, fatigue, and increased risk of infection.
Clinical trials help researchers test the safety and effectiveness of experimental treatments in humans. Through a trial, you might gain access to state-of-the-art therapies.
There’s also a lot to consider. These trials often have strict criteria and involve a time commitment. Talk to your oncologist about clinical trials for people with liver cancer.
For more information, visit the American Cancer Society’s Clinical Trials Matching Service.
In addition to the treatment of cancer, you can also seek help from a palliative care specialist. These specialists are trained to manage pain and other symptoms to improve quality of life.
They will coordinate care with your oncologist and other doctors.
In addition, complementary treatments may help control pain, nausea, and anxiety. Some of these are:
- music therapy
- breathing exercises
Consult with your doctor before starting new therapies. Always make sure you’re working with qualified practitioners.
You might also be interested in trying dietary or herbal supplements. Some can interfere with your medications, so always check with your doctor first. It may also help to meet with a nutritionist or dietitian to go over your nutritional needs.
There are many potential side effects when treating HCC.
Surgery can lead to pain, weakness, and fatigue. Medication to prevent rejection of the transplanted liver can lead to high blood pressure, hair loss or hair growth, and changes in mood.
Other types of medications can cause mouth sores, nausea and loss of appetite, and stomach problems like vomiting, diarrhea, or constipation. It’s important to discuss these side effects with your doctor, as they may be able to provide helpful treatment.
The emotional effects of liver cancer can include sadness, anxiety, and anger.
It helps to take care of yourself by getting rest, eating well, and getting fresh air. Activities like yoga and meditation can also help you manage stress, as can joining a support group.
In cases of depression, therapy and medication can make a big difference. Some medications can interfere with antidepressants, so be sure to discuss this with your doctor.
Meeting and talking to others with similar experiences can help immensely.
Your healthcare provider may connect you with a social worker to help you get you navigate the treatment process and get the right support. Some facilities also incorporate programs involving art, dance, or spa treatments as part of their support services.
Discuss this with your doctor, who may also be able to recommend specific groups or organizations. For more on finding support in your area, visit the American Cancer Society’s Treatment & Support Matching Service.