Your liver balances chemicals in your blood, makes bile to help digest fat, and makes proteins that keep your blood from bleeding. It also clears toxins from your body.
Cancer starts when cells in your liver develop changes (mutations) that make them grow out of control. These cells may form a tumor and can spread to other parts of your body.
Targeted therapy
Cancer cells grow and spread when certain genes in the body change (mutate). Targeted therapy identifies these mutations and treats them with drugs that stop the growth of cancer cells while causing few side effects to healthy cells. Targeted therapies are used to treat both primary liver tumors and those that travel to the liver from another part of the body, called metastatic tumors.
Your doctor may use imaging tests to find tumors and determine how far the cancer has spread. These include ultrasound, computed tomography scans (CT), and magnetic resonance imaging (MRI). Other tests, such as hepatitis C virus antibody panels or antigen tests, can help identify the cause of your liver cancer.
If the cancer is small and limited to a small area of the liver, surgery may be an option. This procedure removes the tumor and some surrounding tissue. It may also involve removing the gallbladder, which is often involved in hepatitis C-related cancers. Surgery is not an option if the tumor takes up too much of the liver, if it has spread beyond the liver, or if you have other serious illnesses.
Other treatment options include radiation and chemotherapy. Chemotherapy uses drugs to kill rapidly growing cancer cells, and it can be given through a vein (IV) or by mouth (pills). Some targeted therapies work by blocking the growth of blood vessels that cancer cells need to get food and oxygen. Drugs that work in this way are called angiogenesis inhibitors.
Radiation therapy can be used to destroy a tumor and limit damage to normal liver tissue. Some newer radiation treatments are being tested in clinical trials. These include stereotactic body radiation therapy and proton beam radiation.
Talk with your doctor about all the treatment options available for you. Be sure to discuss the goals of each treatment and the risks and benefits of each. Your doctor will explain what to expect during treatment and what to do if you have side effects. It is important to tell your doctor about any over-the-counter medications or supplements you are taking, as some may interact with your cancer medication and reduce its effectiveness.
Embolization
The liver is a large organ that’s behind your ribs on the right side of your body, under your lungs. It is a part of your digestive system, making bile that helps you digest food and makes proteins to help your blood clot (stop bleeding). The liver also filters the blood from the rest of your body, cleaning it of harmful substances. The liver cells can sometimes change and grow out of control, forming a mass called a tumor. Cancer that starts in the liver is called primary cancer, while cancer that starts in other areas of the body and spreads to the liver is called secondary cancer or metastatic cancer.
Liver cancer usually starts in the cells that make up your liver, called hepatocytes. But it can also start in other types of liver cells, such as those that line the bile ducts. This type of cancer is called intrahepatic cholangiocarcinoma. Liver cancer can also start in other cells in your body, such as those of the colon, breast or stomach, and then spread to your liver. This type of cancer is called metastatic cancer.
Your doctor can diagnose liver cancer with imaging tests and blood tests. Your doctor may also perform a biopsy to remove a small sample of liver tissue for examination under a microscope. This test can help your doctor determine if the cancer is growing quickly and if it has spread.
Another way to find out if you have liver cancer is to measure the blood flow through your liver with an ultrasound test, which measures how well the liver is functioning. The test can give your doctor a good idea of how advanced the disease is and what kind of treatment might be best for you.
An embolization procedure is a minimally invasive procedure that stops blood flow in a target area while keeping other areas of the body healthy. Your doctor places a catheter into the blood vessel that supplies the area that’s bleeding. Using image guidance, they move the catheter to the correct location and then use a variety of materials to block the blood vessel. They can be used to treat a number of conditions, including abnormal bleeding from certain cancers or other tumors, stomach ulcers, long menstrual periods and varicocele, a condition that causes swollen, enlarged veins in your groin.
Chemotherapy
Medications can kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy drugs may be given orally (by mouth) or through a vein (intravenously). Your doctor will recommend the best dose for you based on the size of your tumor, its stage and how fast it is growing. Medications may be used alone or in combination with other treatments.
If your liver cancer is in the early stages, surgery may be able to remove it and some healthy tissue around it. This is called partial hepatectomy. Depending on how large your tumor is, you may need to have a smaller portion of your liver removed (for example, a wedge of tissue or up to 75 percent of the liver). If this is done, your remaining liver will take over the functions of the resected liver and regrow to the same size as your normal liver.
Partial hepatectomy is also recommended for secondary liver cancer, which has spread to the rest of your liver or other parts of your body. It can significantly improve your chances of survival if the tumor hasn’t recurred after surgery.
In the absence of a surgical option, your doctor may treat your liver cancer with interventional radiology procedures or chemotherapy. These minimally invasive procedures use imaging guidance to target your liver tumors through small injections or needle placements. They can be performed in the hospital as outpatient procedures, which shorten your stay compared to surgical operations. Tumor ablation is a technique that uses extreme heat (radiofrequency or microwave ablation) or cold (cryosurgery) to destroy the tumor. Chemoembolization is a procedure that uses tiny pellets soaked with anticancer drug to block the blood flow to your liver tumor. Most of the drug stays near the tumor, while only a small amount reaches other parts of your body.
Radiation can be delivered externally using X-rays or implanted inside your body near the tumor as a particle beam, called proton therapy. It can help shrink a tumor and relieve pain by killing cancer cells and reducing swelling.
During treatment, your doctor will monitor your liver function and your overall health with tests such as blood work and ultrasounds. Your doctor will discuss your options with you, and you can make decisions about your care in partnership with your doctors through a process called shared decision-making.
Radiation
Radiation uses high-energy rays to destroy cancer cells. It may be given as a single treatment or combined with other treatments.
The goal of radiation for liver cancer is to kill the tumor and prevent it from recurrence. The type of radiation used depends on the size, location and stage of the cancer. Your doctor will review your options and recommend the best one for you.
For advanced liver cancer, doctors often use targeted therapy or ablation techniques to treat the entire tumor along with some healthy surrounding tissue. This improves survival and can relieve symptoms. Other treatment options include removing the cancer surgically, if possible; and chemotherapy or radiation to stop it from growing.
These minimally invasive procedures use image guidance to place needles or make small injections in or around the tumor. They can freeze or burn tumors (radiofrequency or microwave ablation) or deliver chemotherapy drugs directly into the tumor (chemoembolization). Some of these procedures are done as outpatient operations, resulting in shorter hospital stays than surgery.
For some people, radiation can be the only treatment needed to control their cancer. This is especially true if the cancer is in an unfavorable position in the liver or has spread to other organs. Radiation can also be used to relieve symptoms of liver cancer, such as pain and nausea.
Depending on your specific circumstances, your doctor may prescribe stereotactic body radiation therapy (SBRT) or ablative radiotherapy. These advanced techniques help deliver higher doses of radiation to hard-to-reach areas of the body, such as the liver, while sparing healthy tissue.
SBRT is a radiation treatment that delivers many beams of high-dose radiation from different angles to the tumor in fewer treatment sessions. We can precisely target your tumour with this technique because it is guided by imaging tests, such as CT scans and ultrasound. We can also adjust the timing of your treatment, so that we only expose healthy tissue to radiation when you breathe in and out.
During ablative radiotherapy, your doctor will insert an instrument called a cryoprobe into the hepatic artery that supplies blood to the tumor. This device will then freeze the blood vessels that supply the tumor, and the cancer cells inside the liver. The cancer cells will die from lack of blood and radiation exposure, reducing the size of the tumor and helping to manage your symptoms.
