Treatment Options for Liver Cancer

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Although there are many treatment options for liver cancer, but generally all types of this disease are difficult to treat. Secondary type or metastatic liver cancer (cancer cells from other parts of the body that spread to the liver) is relatively more difficult to cure, because this type usually has already spread. And for primary type (cancer in the liver that begins from the cells in the liver) is also rarely diagnosed at early stage (the most treatable stage).

You might also like to read about best foods to prevent cancer and other helpful tips to prevent liver cancer, before continuing!

The disease usually also doesn’t generate any clearly and noticeable symptoms at early stage. If the symptoms do occur, they are usually very vague. Therefore, many patients usually don’t realize when they have liver cancer until it gets worse into the more advanced stage.

Furthermore, there are also a lot of complex networks of bile ducts and blood vessels in the liver. These are also often affected by the cancer, which then will make the treatment option of surgery is difficult. With these explanations, it’s reasonable that most of the treatment is more focused on increasing the survival rate and making patient feel better, unless the cancer is diagnosed at early stage.

How to diagnose liver cancer? How do you know if you have it?

If you in doubt to your health, you are most likely to see a doctor (your family doctor) for clearly diagnosis. Then your doctor usually will ask about the general health. 

If you notice some symptoms of liver cancer, allow your doctor to know – particularly about how long you have had them. Then your doctor may suggest some further tests if necessary to find a clearly diagnosis. To perform these tests, your doctor usually will recommend you to see a specialist at a local hospital.

A specialist then will ask you about your symptoms and overall medical history. Then he /she usually will closely analyze and examine your tummy. In making a diagnosis, it’s important for the specialist to find whether your cancer is primary liver cancer type or secondary type, and the stage of cancer! 

To find a clearly diagnosis, your specialist may recommend some of the following tests:

Blood tests

Blood tests are common choices to diagnose a lot of kind of diseases, including for liver cancer. These tests can be used to closely examine the performance of the liver – whether it is working properly or improperly.

LFT (liver function tests) is one of common procedures to reveal the abnormalities in the liver. However, we need to clearly understand that the abnormalities in the liver can be caused by many different causes other than cancer. 

ADP (alpha-fetoprotein) test is another common blood test. It is usually used to get to know the alpha-fetoprotein level in the blood. In many cases, the level of AFP is high in patients with hepatocellular cancer (the most common type of primary liver cancer). 

For patients with liver cancer, LFT also can be used to examine /analyze how well the organ (liver) works before & after, and during the treatment. And sometimes doctors may also use AFP test to analyze the effectiveness of the treatment – whether or not it works successfully?!

Imaging tests

Your specialist may also need to perform some imaging tests to find a clearly diagnosis. These may include:

1. MRI scan test! MRI stands for ‘Magnetic Resonance Imaging’ – sometimes it can be an effective way to find signs of cancer in certain parts of the body, including the cancer cells in the liver. 
2. CT (computerized tomography) scan test! It also can be used to look signs of cancer cells in the liver or other parts of the body. Sometimes, it is also used to find cancer cells that have spread from certain organ to other organs of the body. 
3. An ultrasound scan test! It involves a high frequency wave of sound to result a picture of an organ /part of the body, which then will be used to closely examine whether there are abnormal cells that grow in the liver. Before taking the test, patient is usually asked to avoid eating for about 4 hours before performing this scan test.

Laparoscopy

This test is one of the effective options to diagnose a liver cancer without needing a big surgery. In this test, your specialist will use an appropriately device called ‘laparoscope’ (it is flexible and small tube that has a small camera). 

To insert a laparoscope into the abdomen of patient, first your specialist needs to create a small cut. Inserting laparoscope will allow your specialists to closely look the liver, so thus they can examine whether there is any sign of cancer. Sometimes laparoscopy test is also helpful to determine the stage of the liver cancer.

In addition when a patient needs to take laparoscopy test, he /she usually do it under general anaesthetic. Therefore, patient usually will need to stay in hospital overnight. After the test, patients will have a small wound with a couple of stitches. If the specialists need to insert the laparoscope through more than one cut, patient will have more than one small wound.

Removing /taking a sample of liver tissue!

This procedure is often called ‘biopsy’ – the biopsy itself means removing a sample of tissue which then will be closely examined under a microscope. Removing a sample tissue is also often used to determine whether the abnormal cells of tumor is malignant (cancerous) or benign (non-cancerous). 

With biopsy, the specialists are usually also able to determine whether the cancer is secondary or primary liver cancer. Before deciding to choose biopsy option, your specialists need to closely analyze the pros and cons – particularly they need to ensure that this procedure is safe enough for you!

But if your specialists think that your body is able to take a liver transplant, or if the tumor could be removed and the cancer has not spread – you may be not suggested to perform biopsy, because there is a risk for the cancer cells to spread along the pathway of needle in biopsy procedure.

Biopsy procedure usually needs the clearly picture (more detailed picture) of your body because this procedure requires to put the biopsy needle into the correctly place. 

Therefore if you are going to take a biopsy, first your specialist usually will ask you to take imaging tests (like CT /ultrasound test). Then the specialist will use the information of the result of these imaging tests for a guide where the biopsy needle should be inserted.

After the biopsy test, you should stay in hospital overnight or for a few hours. Because as well we know that liver contains very rich blood supply, and that’s why there is a risk of bleeding after the test.

Moreover, you usually will not get the result of the test straight away. Because as mentioned before, the specialists need to closely examine the removed sample tissue under a microscope before making a final conclusion!

Treatment options for primary liver cancer

There are three major factors that influence the kind of treatment you need to take – according to the UK Cancer Research. These include: the liver cancer type, stage of cancer, and overall health of your body.

In other words, these factors usually also affect what is kind of treatment that will work best for you! And depending on the circumstances of each patient, the treatment may only involve a single type of treatment or the combination of different treatments.

In general, surgery and chemotherapy are the most common options of the treatment. Other treatment options may include the liver transplant, biological therapy, chemoembolisation, RFA (radiofrequency ablation), radiotherapy, cryotherapy, etc.

A case of liver cancer usually will be considered by several doctors and specialists. This team may include: surgeons, hepatologist (a specialist of liver disease), gastroenterologist (a specialist of digestive system), and one /some other cancer specialists.

Surgery

The appropriately surgery is needed to remove the cancer or the affected section of the liver. The large size of part of the liver that will be removed is dependent to the circumstances of each patient. The surgery may only remove a small wedge of the liver, or even 80 percent of the liver.

The tissue of the liver that is removed can naturally grow back – even when more half part of liver is removed, it usually can grow back naturally to the normal size. But in patients with cirrhosis (scarring in the liver), the removed tissues may not grow back as well as in patients without cirrhosis.

The liver transplant surgery

In many cases, a liver transplant is the most successful treatment to treat the cancer and promote a better prognosis for patient. But unfortunately, not all patients are able to have it. In general, patients at early stage of liver cancer are more likely to be able to have a liver transplant. 

HCC (Hepatocellular cancer) is the most common type of primary liver cancer. It tends to develop in individuals with chronic cirrhosis or long term liver damage. Your doctors may recommend a liver transplant if you have one of the following reasons:

1. There is still only a single tumor, and its size is less than 5 centimeters across.
2. There is more than one tumor (up to 3 tumors), but all of these tumors are less than 3 centimeters in size.
3. You have a single tumor in the liver (its size is 5 – 7 centimeters but it hasn’t grown for at least 6 months).

The liver transplant itself means the affected liver is removed which then will be replaced by a donated liver. Therefore, sometimes patients may need to take weeks or month to get a healthy liver from a donor that closely matches to their affected liver.

And during this delay, there is a chance for the cells of cancer in the liver to keep growing. Therefore during this period, you may need to take other appropriately treatments to control the progress and growth of the cancer.

Chemotherapy treatment

Chemotherapy is used to shrink the tumor (especially if it cannot be treated /removed with surgery option). That’s why the goal of chemotherapy is usually intended to control the symptoms and to slow the progress /growth of the cancer cells.

For liver cancer in children (such as hepatoblastoma), chemotherapy is often used (commonly prescribed before and after the surgery). The use of chemotherapy before surgery is aimed to shrink the cells of cancer. And if it is used after surgery, it is usually aimed to reduce the risk of cancer from coming back!  

In addition, there is also a method called ‘transarterial infusion chemotherapy’. It means directly giving chemotherapy into the major liver artery. In this procedure, a very high dose of chemotherapy is used to powerfully shrink the tumor. 

Sometimes chemotherapy is also directly given into the liver – this is often called ‘chemoembolisation’. In this procedure, doctors usually also inject a gelatin sponge to block the blood that flows into the affected section of liver, so thus the cancer cells will not get the supply of foods & oxygen and then they may go to shrink. 

Cryotherapy option

It is a kind of procedure to freeze the tumor, which also familiar called as ‘cryosurgery’. Though freezing tumor is not common option to treat primary liver cancer, but it is one of choices if patients are not able to take a surgery. 

Cryosurgery uses a mental probe that is putted in the affected section of liver. This probe has liquid nitrogen that can freeze any nearby tissue around it, so thus this freezing will destroy the cancer.

However, cryosurgery can be painful. Therefore, some painkillers are usually prescribed to control this pain. After the treatment, these painkillers usually only last for a short period of time - and some patients may experience fever afterwards.

RFA (radiofrequency ablation ‘destroying’)

As the name suggests, radio waves are used in this treatment. The use of radio waves is aimed to kill the cells of cancer by heating up these abnormal cells. 

It’s important to insert the RFA needle in the appropriately place of the body. Therefore before taking RFA, your specialists need to perform some imaging tests (such ultrasound scan). The result of imaging test will be used for a guide to place the needle that transfers the radio waves which then heat up and kill the cancer cells. 

But for patients who have very big tumor or if the cancer is too close with the major blood vessels, RFA is not the option due to the high risk of developing severe bleeding.

Killing the cancer cells with radiotherapy

Although radiotherapy may be powerful to kill the cancer, but it is not commonly used because there is a risk for the radiation that also can kill the healthy cells of liver. In general, it is usually more likely to be used to treat bile duct cancer than hepatocellular cancer.

Biological therapy

As the name implies, it is a kind of treatment that involves & uses natural substance of the patient’s body or special drugs made from the own substance of patient’s body.

There are some types of biological therapy -- sorafenib (also familiar called as ‘TKI or tyrosine kinase inhibitor‘) is one of biological therapy types. Tyrosine kinase is a kind of protein that can be functioned as a chemical messenger. Unfortunately sorafenib is still not recommended by NHS because it is not cost effective.

Injection the appropriately alcohol into the tumor

During this procedure, the special pure alcohol is directly injected into the tumors in the liver. This injection can be done during a surgery (operation) or through the skin. The directly injection of alcohol is aimed to cause the cells of tumor to die. 

Treatment options for recurrence liver cancer

There is also a chance for a cancer to reoccur in the liver after its initial treatment. This recurrence cancer can come back in the nearby organs of the liver, the liver itself, lungs, bones, or in other parts of the body.

For this recurrence case, the specialists may recommend higher dose of chemotherapy, more surgery, or some of the mentioned treatments above – depending on the circumstances of each patient (particularly such as the type of cancer, the treatments that have taken before, general health of patient, and whether the cancer has spread).

How about with the liver cancer alternative treatment?

According to an article published on MayoClinic -- the alternative treatments are usually more focused to control & relieve pain in patients who have advanced liver cancer. These may include;

1. massage therapy
2. deep breathing therapy
3. acupressure therapy
4. music therapy
5. and acupuncture therapy to make you more relax

Ask your doctor for more detailed information about the kind of alternative treatment that will work best and help you to cope with the pain!