liver cancer treatment
The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Specialists who treat liver cancer include surgeons, transplant surgeons, gastroenterologists, medical oncologists, and radiation oncologists.
Treatment choicesCancer of the liver is very hard to control with current treatments. For that reason, many doctors encourage patients with liver cancer to consider taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of liver cancer.
The choice of treatment depends on the condition of the liver; the number, size, and location of tumors; and whether the cancer has spread outside the liver. Other factors to consider include the patient's age, general health, concerns about the treatments and their possible side effects, and personal values.
Usually, the most important factor is the stage of the disease. The stage is based on the size of the tumor, the condition of the liver, and whether the cancer has spread. The following are brief descriptions of the stages of liver cancer and the treatments most often used for each stage. For some patients, other treatments may be appropriate.
Localized resectable cancerLocalized resectable liver cancer is cancer that can be removed during surgery. There is no evidence that the cancer has spread to the nearby lymph nodes or to other parts of the body. Lab tests show that the liver is working well.
Surgery to remove part of the liver is called partial hepatectomy. The extent of the surgery depends on the size, number, and location of the tumors. It also depends on how well the liver is working. The doctor may remove a wedge of tissue that contains the liver tumor, an entire lobe, or an even larger portion of the liver.
In a partial hepatectomy, the surgeon leaves a margin of normal liver tissue. This remaining healthy tissue takes over the functions of the liver.
For a few patients, liver transplantation may be an option. For this procedure, the transplant surgeon removes the patient's entire liver (total hepatectomy) and replaces it with a healthy liver from a donor. A liver transplant is an option only if the disease has not spread outside the liver and only if a suitable donated liver can be found. While the patient waits for a donated liver to become available, the health care team monitors the patient's health and provides other treatments, as necessary.
Localized unresectable cancerLocalized unresectable liver cancer cannot be removed by surgery even though it has not spread to the nearby lymph nodes or to distant parts of the body. Surgery to remove the tumor is not possible because of cirrhosis (or other conditions that cause poor liver function), the location of the tumor within the liver, or other health problems.
Advanced cancerAdvanced cancer is cancer that is found in both lobes of the liver or that has spread to other parts of the body. Although advanced liver cancer cannot be cured, some patients receive anticancer therapy to try to slow the progress of the disease. Others discuss the possible benefits and side effects and decide they do not want to have anticancer therapy. In either case, patients receive palliative care to reduce their pain and control other symptoms.
Treatment for advanced liver cancer may involve chemotherapy, radiation therapy, or both:
Recurrent cancerRecurrent cancer means the disease has come back after the initial treatment. Even when a tumor in the liver seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Most recurrences occur within the first 2 years of treatment. The patient may have surgery or a combination of treatments for recurrent liver cancer.
Side effects of treatmentBecause cancer treatment may damage healthy cells and tissues, unwanted side effects often occur. Side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. The health care team will explain the possible side effects of treatment and how they will help the patient manage them.
SurgeryIt takes time to heal after surgery, and the time needed to recover is different for each person. Patients are often uncomfortable during the first few days. However, medicine can usually control their pain. Patients should feel free to discuss pain relief with the doctor or nurse. It is common to feel tired or weak for a while. Also, patients may have diarrhea and a feeling of fullness in the abdomen. The health care team watches the patient for signs of bleeding, infection, liver failure, or other problems requiring immediate treatment.
After a liver transplant, the patient may need to stay in the hospital for several weeks. During that time, the health care team checks for signs of how well the patient's body is accepting the new liver. The patient takes drugs to prevent the body from rejecting the new liver. These drugs may cause puffiness in the face, high blood pressure, or an increase in body hair.
CryosurgeryBecause a smaller incision is needed for cryosurgery than for traditional surgery, recovery after cryosurgery is generally faster and less painful. Also, infection and bleeding are not as likely.
Percutaneous ethanol injectionPatients may have fever and pain after percutaneous ethanol injection. The doctor can suggest medicines to relieve these problems.
Chemoembolization and hepatic arterial infusionChemoembolization and hepatic arterial infusion cause fewer side effects than systemic chemotherapy because the drugs do not flow through the entire body. Chemoembolization sometimes causes nausea, vomiting, fever, and abdominal pain. The doctor can give medications to help lessen these problems. Some patients may feel very tired for several weeks after the treatment.
Side effects from hepatic arterial infusion include infection and problems with the pump device. Sometimes the device may have to be removed.
Systemic chemotherapyThe side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. As with other types of treatment, side effects are different for each patient.
Systemic chemotherapy affects rapidly dividing cells throughout the body, including blood cells. Blood cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When anticancer drugs damage blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is complete. The health care team can suggest ways to relieve side effects.
Radiation therapyThe side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Radiation therapy to the chest and abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation therapy also may cause a decrease in the number of healthy white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them.
Pain controlPain is a common problem for people with liver cancer. The tumor can cause pain by pressing against nerves and other organs. Also, therapies for liver cancer may cause discomfort.
The patient's doctor or a specialist in pain control can relieve or reduce pain in several ways:
NutritionPeople with liver cancer may not feel like eating, especially if they are uncomfortable or tired. Also, the side effects of treatment can make eating difficult. Foods may smell or taste different. Nevertheless, patients should try to eat enough calories and protein to control weight loss, maintain strength, and promote healing. Also, eating well often helps people with cancer feel better and have more energy.
Careful planning and checkups are important. Liver cancer and its treatment may make it hard for patients to digest food and maintain their weight. The doctor will check the patient for weight loss, weakness, and lack of energy.
Continuing careContinuing care for patients with liver cancer depends on the stage of their disease and the treatments they have received. Followup is very important after surgery to remove cancer from the liver. This is because the cancer can return in the liver or in another part of the body. People who have had liver cancer surgery may wish to discuss the chance of recurrence with the doctor. Followup care may include blood tests, X-rays, ultrasound tests, CT scans, angiograms, or other tests.
For people who have had a liver transplant, the doctor will test how well the new liver is working. The doctor also will watch the patient closely to make sure the new liver is not being rejected. People who have had a liver transplant may want to discuss with the doctor the type and schedule of followup tests that will be needed.
For patients with advanced disease, the health care team will focus on keeping the patient as comfortable as possible. Medicines and other measures can help with digestion, reduce pain, or relieve other symptoms.
Support for people with liver cancerHaving a serious disease such as liver cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group. Groups may offer support in person, over the telephone, or on the Internet.
Patients may worry about caring for their families, holding on to their jobs, or keeping up with daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team will answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for emotional support, financial aid, transportation, or home care.
The promise of cancer researchLaboratory scientists are studying the liver to learn more about what may cause liver cancer and how liver cancer cells work. They are looking for new therapies to kill cancer cells.
Doctors in hospitals and clinics are conducting many types of clinical trials. These are research studies in which people take part voluntarily. In these trials, researchers are studying ways to treat liver cancer that have shown promise in laboratory studies. Research has led to advances in treatment methods, but controlling liver cancer remains a challenge. Scientists continue to search for more effective ways to treat this disease.
Patients who join clinical trials have the first chance to benefit from new treatments. They also make an important contribution to medical science. Although clinical trials may pose some risks, researchers take very careful steps to protect people.
Currently, clinical trials involve chemotherapy, chemoembolization, and radiofrequency ablation for the treatment of liver cancer. Another approach under study is biological therapy, which uses the body's natural ability (immune system) to fight cancer. Biological therapy is being studied in combination with chemotherapy.
Related category• HEALTH AND DISEASE
Source: National Cancer Institute
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