Your treatment plan
Your recommended treatment plan will depend on the stage your liver cancer is at.
If your cancer is at stage A when diagnosed, a complete cure may be possible.
The 3 main ways this can be achieved are:
- removing the affected section of liver (a resection)
- having a liver transplant, where you have an operation to remove the liver and replace it with a healthy one
- using heat to kill cancerous cells (microwave or radiofrequency ablation, or RFA)
If your cancer is at stage B or C, a cure is not usually possible. But chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years.
There are also medicines, such as sorafenib, lenvatinib and regorafenib, which are a possible treatment for some people.
If your cancer is at stage D when diagnosed, it's usually too late to slow down the spread of the cancer.
Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.
If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery.
This procedure is known as surgical resection.
As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health.
But in the majority of people with liver cancer, their liver's regenerative ability may be significantly impaired and resection may be unsafe.
Whether or not a resection can be performed is often determined by assessing the severity of scarring of the liver (cirrhosis).
If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you'll be asleep during the procedure and will not feel any pain as it's carried out.
Most people are well enough to leave hospital within 1-2 weeks after having surgery.
But depending on how much of your liver was removed, it may take several months for you to fully recover.
Liver resection is a complicated surgery and can have a considerable impact on your body.
There's a significant risk of complications occurring during and after surgery.
Possible complications of liver resection include:
- infection at the site of the surgery
- bleeding after the surgery
- blood clots that develop in your legs (deep vein thrombosis, or DVT)
- bile leaking from the liver – further surgery may be required to stop the leak
- yellowing of the skin and whites of the eyes (jaundice)
- your liver no longer being able to function properly (liver failure)
Liver resection can also sometimes cause fatal complications, such as a heart attack.
It's estimated around 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.
A liver transplant involves removing a cancerous liver and replacing it with a healthy one from a donor.
This is a major operation, and there's a risk of potentially life-threatening complications.
It's estimated around 1 in 10 people will die at some point in the year after surgery.
A liver transplant may be suitable for you if:
- you only have a single tumour less than 5cm in diameter
- you have a single tumour 5 to 7cm across that has not grown for at least 6 months
- you have 3 or fewer small tumours, each less than 3cm
If you're suitable for a liver transplant, you'll normally need to be placed on a waiting list until a donor liver becomes available.
The average waiting time for a liver transplant is 135 days for adults.
In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.
The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long.
Microwave or radiofrequency ablation
Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm in diameter.
They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.
These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes.
This heat kills the cancer cells and causes the tumours to shrink.
Similar procedures using lasers or freezing can also achieve the same result.
There are 3 main ways microwave ablation or RFA can be carried out:
- where the needles are passed through the skin (percutaneously)
- where the needles are inserted through small cuts in your abdomen (keyhole surgery, also known as a laparoscopy)
- where the needles are inserted through a single large cut made in your abdomen (open surgery)
Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic, where you're awake but the area being treated is numbed, depending on the technique used and the size of the area being treated.
How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between 1 and 3 hours in total.
Most people need to stay overnight in hospital.
You may experience some minor discomfort and flu-like symptoms, such as chills and muscle pains, for a few days after the procedure.
The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.
Chemotherapy uses powerful cancer-killing medicines to slow the spread of liver cancer.
A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer.
In these cases, the treatment can prolong life, but cannot cure the cancer.
TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.
During TACE, a fine tube called a catheter is inserted into the main blood vessel in your groin (femoral artery) and passed along the artery to the main blood vessel that carries blood to the liver (hepatic artery).
Chemotherapy medication is injected directly into the liver through the catheter.
Either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down their growth.
TACE usually takes 1 to 2 hours to complete. After the procedure, you'll stay in hospital overnight before returning home.
This procedure can be completed several times if necessary.
Injecting chemotherapy medicines directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness.
But the procedure is not free from side effects and complications.
The most common side effect is post-chemoembolisation syndrome, which can cause tummy (abdominal) pain and a high temperature, as well as making you be and feel sick.
These symptoms may last for a few weeks after a TACE session.
If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment.
A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.
In most cases, this is carried out under a local anaesthetic, meaning you'll be awake, but the affected area is numbed so you will not feel any pain.
Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth.
It's a possible treatment for advanced liver cancer, but is only available on the NHS to adults whose liver is working normally.
Lenvatinib is a medication given in capsule form that can also slow the growth of liver cancer.
Like sorafenib, it's a possible treatment option for advanced liver cancer, but is only available on the NHS to adults if:
- surgery is not a treatment option
- whose liver is working normally
- they're well enough to carry out daily activities like light housework or office work
Regorafenib is a new medicine for adults with advanced liver cancer who have been previously treated with sorafenib.
It's only available on the NHS to people whose liver is working normally.
Regorafenib is taken as daily tablets.
Pain relief for advanced liver cancer
Treatment for advanced liver cancer focuses on relieving symptoms like pain and discomfort, rather than attempting to slow down the progression of the cancer.
Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine.
Feeling sick and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.
As the current methods of curing liver cancer are limited, you may want, or be asked, to take part in a clinical trial as part of your treatment.
Clinical trials are studies that use new and experimental techniques to see how well they work in treating or curing cancer.
But if you agree to take part in a clinical trial, be aware there's no guarantee the technique being studied will be any more effective than standard treatments for liver cancer.