How Is Liver Cancer Treated

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Embolization Therapy For Liver Cancer

Minimally Invasive Treatment for Liver Cancer | Sid Padia, MD | UCLAMDChat

Embolization is a procedure that injects substances directly into an artery in the liver to block or reduce the blood flow to a tumor in the liver.

The liver is special in that it has 2 blood supplies. Most normal liver cells are fed by the portal vein, whereas a cancer in the liver is mainly fed by the hepatic artery. Blocking the part of the hepatic artery that feeds the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.

Embolization isan option for some patients with tumors that cannot be removed by surgery. It can be used for people with tumors that are too large to be treated with ablation and who also have adequate liver function. It can also be used with ablation. Embolization can reduce some of the blood supply to the normal liver tissue, so it may not be a good option for some patients whose liver has been damaged by diseases such as hepatitis or cirrhosis. It isnt yet clear which type of embolization has a better long-term outcome.

People getting this type of treatment typically do not stay in the hospital overnight.

Liver Cancer Treatment Options

City of Hope has one of the most renowned liver cancer programs in the United States, with a multidisciplinary team of medical experts across different fields including surgery, radiation oncology, medical oncology and supportive care medicine.

Members of our liver cancer team meet twice weekly to review patient cases, bringing a variety of clinical perspectives and experience to the development of an individualized treatment plan. The team also participates in a weekly meeting to share clinical trial results, review information from surgical pathology reports and plan future research studies.

Our physicians are also active members in many collaborations and cooperative groups, and have led or participated in most national clinical trials for detecting, treating and preventing liver cancer. This dedication to research also ensures our patients have access to the most promising and leading-edge liver cancer therapies.

Learn more about our liver cancer treatment options below:

What Is The Life Expectancy Of Liver Cancer

Healthcare providers are making progress on liver cancer treatment so people can live longer. But liver cancer remains a life-threatening disease.

Data show that 35% of people treated for early-stage hepatocellular carcinoma liver are alive five years after diagnosis. About 12% of people treated for HCC that has spread to nearby tissues organs or lymph nodes are alive five years after diagnosis. About 3% of people treated for HCC that has spread further are alive five years after diagnosis.

The five-year survival rates for intrahepatic bile duct cancer are 24% for bile duct that hasnt spread outside of your liver, 9% for cancer thats spread to nearby lymph nodes and 2% for cancer thats spread further.

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Treatment Of Liver Cancer By Stage

Although the AJCC staging system is often used to describe the spread of a liver cancer, doctors use a more practical system to determine treatment options. Liver cancers are often categorized as:

  • Potentially resectable or transplantable cancer
  • Unresectable cancer that has not spread
  • Advanced cancer

Thinking About Taking Part In A Clinical Trial

Childhood Liver Cancer Treatment (PDQ®)Health Professional Version ...

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

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Radiation Therapy For Liver Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It may not be a good option for some patients whose liver has been greatly damaged by diseases such as hepatitis or cirrhosis.

Radiation can be helpful in treating:

  • Liver cancer that cannot be removed by surgery
  • Liver cancer that cannot be treated with ablation or embolization or did not respond well to those treatments
  • Liver cancer that has spread to other areas such as the brain or bones
  • People with pain because of large liver cancers
  • People with a tumor thrombus blocking the portal vein.

Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, its important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent liver cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

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Key Points About Liver Cancer

  • Hepatocellular carcinoma is the most common kind of liver cancer in adults. It starts in the main cells in the liver, the hepatocytes.
  • Liver cancer may not cause symptoms until it’s quite large.
  • Symptoms vary, but they can include bloating, belly pain. loss of appetite, weight loss, itching, and yellowing of the skin and eyes.
  • Blood tests, ultrasound, imaging scans, and sometimes a biopsy can be used to diagnose liver cancer.
  • Treatment can include surgery, tumor ablation, embolization, targeted therapy, and immunotherapy. Radiation and chemotherapy aren’t commonly used.

Can Primary Liver Cancer Be Prevented

Liver Cancer Treatment Options at Roswell Park

Prevention is the best defence against primary liver cancer. Worldwide, the most common risk factors for primary liver cancer are chronic hepatitis B and C infections. Therefore, the prevention of these forms of liver disease is essential. The Canadian Liver Foundation recommends that all children, as well as adults at high risk of being exposed to the virus, should be vaccinated against hepatitis B.

Since there is no vaccine against hepatitis C, it is crucial to prevent the spread of this disease and to identify and assess all those who are already infected with the hepatitis C virus for treatment. The Canadian Liver Foundation recommends that all people with risk factors and adults born between 1945 and 1975 should get tested for hepatitis C.

Alcohol intake should be limited to no more than one to two standard drinks per day. Drinking alcohol every day, as well as binge drinking, can be harmful to your liver. If you already have a liver disease, the safest amount of alcohol is no alcohol at all.

As mentioned earlier, non-alcoholic fatty liver disease and its most severe form, non-alcoholic steatohepatitis is a big risk factor for liver cancer. It is important to maintain a healthy body weight, eat a well-balanced diet, and introduce physical activity into your daily routine.

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Choice Of Staging System

There is no consensus as to which staging system is the best, and studies comparing different staging systems have shown variable prognostic values of these systems in various patient populations . Because there is great heterogeneity in geographic variations of treatment approaches and severity of underlying liver functions, it is clear that no universal staging system will accurately accommodate all patient and tumor variables. It is likely that a certain scoring system would be optimal for a certain patient population. For example, pathologic staging systems such as the AJCC TNM staging system may be superior to clinical systems in prognosis classification for patients with surgical resection, whereas clinical systems, such as BCLC and CLIP systems, may have more prognostic value for patients with advanced HCC and cirrhosis who are not candidates for surgery . Further studies are needed to improve the current staging systems and to provide sufficient flexibility for clinical application of these systems across a broader range of patient populations. For convenience, this chapter uses the BCLC system to discuss treatment for liver cancer in the present context.

What Are Treatment Side Effects

Cancer treatment such as targeted therapy, immunotherapy, and radiation can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting.

Talk with your healthcare provider about side effects linked to your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

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Heavy And Harmful Drinking

The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs and is capable of regenerating itself. But despite the liver’s resilience, excessive alcohol intake over many years can damage it.

Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this and it can become damaged and scarred over time.

Systemic Therapy For Advanced Hcc

Treatment Available for Liver Cancer: What Are Your Options?

The treatment plan for later stage HCC may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous tube placed into a vein using a needle, an injection into a muscle or under the skin, or as a pill or capsule that is swallowed . If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for advanced HCC include:

  • Targeted therapy

The first-line treatment is the initial treatment given. First-line therapy options for advanced HCC include:

  • The combination of bevacizumab with atezolizumab may be offered to some patients with advanced HCC.

  • Targeted therapy with sorafenib or lenvatinib may be offered to people who are unable to receive atezolizumab with bevacizumab. See more under Targeted therapy below.

A second-line treatment is given if the first-line treatment does not work. Second-line therapy options for advanced HCC include:

Targeted therapy

Anti-angiogenesis therapies include:

Immunotherapy

Immunotherapies for HCC include:

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Treatment For Early Liver Cancer

For patients with early-stage hepatocellular carcinoma, a partial hepatectomy may be curative however, a patients overall liver function, tumor assessment, and liver anatomy must be taken into consideration. Resection is recommended in patients who have preserved liver function, generally ChildPugh class A without portal hypertension. Liver transplantation also offers patients a potential curative treatment option in early hepatocellular carcinoma.

How Is Radiation Therapy Given

External beam radiation therapy focuses radiation from a source outside of the body on the cancer. Getting radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment usually takes longer. Most often, EBRT treatments are small doses of radiation given 5 days a week for several weeks.

Although liver cancer cells are sensitive to radiation, much care is taken when planning the treatment to avoid damaging normal liver tissue as much as possible. Newer radiation techniques, such as stereotactic body radiation therapy , help doctors target liver tumors while reducing the radiation to nearby healthy tissues. This makes it more effective and reduces side effects. SBRT allows treatment to be completed in a short-time compared to EBRT. It uses very focused beams of high-dose radiation given on one or a few days. Beams are aimed at the tumor from many different angles. To focus the radiation precisely, the person is put in a specially designed body frame for each treatment. This type of radiation may be used in people with small cancers who are waiting for a liver transplant.

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What Are The Treatments For Hepatocellular Carcinoma

The treatment of HCC depends on the extent of tumour spread , the speed of tumour growth, and the overall health condition of the person. Staging is often done by imaging of the body, including CT scans, MRIs, and bone scans. Small primary cancers of the liver are curable. Cure rates generally decrease as the tumour size increases. Treatment of liver cancer may involve surgery, radiation therapy and chemotherapy or liver transplantation.

Liver Tumor Ablation Techniques

Innovative Treatments in Liver Cancer

Ablation therapies kill a liver tumor instead of removing it. In these techniques, doctors use a probe to kill tumors with hot energy. This minimally invasive approach is most effective for smaller tumors less than 3 cm.

At Johns Hopkins, experts perform microwave ablation on tumors that are not removable via other surgical interventions. This technique can be performed either surgically in the operating room or by interventional radiologists.

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How Is Primary Liver Cancer Diagnosed

To diagnose liver cancer, the doctor, usually a liver specialist , will ask about your medical history, identify risk factors and symptoms, and perform a physical exam. Imaging tests, such as an ultrasound, a computed tomography scan, or a magnetic resonance imaging study, may also be done. Blood work to check liver function and to measure the levels of certain substances, such as alpha-fetoprotein, or AFP , may also be necessary.

In some cases, diagnosis requires a biopsy. In this procedure, a doctor removes a small piece of liver tissue, and a pathologist examines it under a microscope for the presence of cancer cells. Tissue may be biopsied using a needle thats guided by ultrasound, MRI, or CTor by using a laparoscope, a thin tube equipped with a camera and surgical instruments that is inserted through a small incision in the abdomen.

If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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How Do Healthcare Providers Treat Liver Cancer

Healthcare providers have several common treatments for HCC and IHC, including surgery to remove part of your liver, liver transplantation and liver-directed treatments like hepatic arterial embolization and ablation. They may also use several types of chemotherapy, chemoembolization, radiation therapy, radioembolization, immunotherapy and targeted therapy.

What Affects Survival

Pin on Liver Transplant/Liver Cancer Treatments

Your outlook is affected by the treatment you have.

Treatment decisions depend on the size of the cancer and whether it has spread. It also depends on the health of your liver tissue that is not affected by the cancer, for example if you have liver cirrhosis.

Your general health and fitness also affects survival.

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Types Of Liver Cancer

There are several types of primary liver cancer. Each one corresponds to a different part of the liver or type of liver cell that is affected. Primary liver cancer can start as a single lump growing in your liver, or it can start in many places within your liver at the same time.

The main types of primary liver cancer are:

Causes Of Liver Cancer

The exact cause of liver cancer is unknown, but many cases are linked to a problem with the liver called cirrhosis. This is where the tissue of the liver has become scarred and cannot perform many of its usual functions.

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour.

In cases of liver cancer, it is uncertain why and how the cells of the liver are affected, but it appears that cirrhosis can increase a person’s chances of developing the condition.

However, most cases of cirrhosis do not lead to liver cancer, and people without cirrhosis can also develop liver cancer.

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