Liver Cancer Treatment

There are different types of treatment for people with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

Types of treatment

Surveillance

Surveillance is used for lesions smaller than 1 centimeter found during screening. Follow-up every 3 months is common. Surveillance is closely watching a person's condition but not giving any treatment unless there are changes in test results that show the condition is getting worse. During active surveillance, certain exams and tests are done on a regular schedule.

Surgery

A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.

Liver transplant

In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the person has to wait for a donated liver, other treatment is given as needed.

Ablation therapy

Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:

• Radiofrequency ablation: Special needles are inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells.
• Microwave therapy: The tumor is exposed to high temperatures created by microwaves. This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
• Percutaneous ethanol injection: A small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Usually local anesthesia is used, but if the person has many tumors in the liver, general anesthesia may be used.
• Cryoablation: An instrument is used to freeze and destroy cancer cells. This type of treatment is also called cryotherapy and cryosurgery. The doctor may use ultrasound to guide the instrument. Learn more at Cryosurgery to Treat Cancer.
• Electroporation therapy: Electrical pulses are sent through an electrode placed in a tumor to kill cancer cells. Electroporation therapy is being studied in clinical trials.

Embolization therapy

Embolization therapy is used for people who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver. Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow.

The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.

There are two main types of embolization therapy:

• Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
• Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given. The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. This type of treatment is also called chemoembolization.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies used to treat advanced liver cancer include:

Learn more about targeted therapy and its side effects at Targeted Therapy to Treat Cancer.

Immunotherapy

Immunotherapy is a treatment that uses the person's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Immune checkpoint inhibitors are a type of immunotherapy. Immune checkpoint inhibitors that may be used to treat liver cancer include:

• with the targeted therapy drug bevacizumab or cabozantinib
• with
• with

Learn more about immunotherapy and its side effects at Immunotherapy to Treat Cancer and Immunotherapy Side Effects.

Radiation therapy

External radiation therapy uses a machine outside the body to send high-energy x-rays or other types of radiation toward the area of the body with cancer. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. The number of treatments is based on details about the cancer, such as the size and location of the tumor. Certain ways of giving external radiation therapy can help keep radiation from damaging nearby healthy tissue:

• Conformal radiation therapy: Conformal radiation therapy uses a computer to make a 3-dimensional, or 3-D, picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue.
• Stereotactic body radiation therapy: Stereotactic body radiation therapy uses special equipment to place the person in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the person in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
• Proton beam radiation therapy: Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (tiny particles with a positive charge) to kill tumor cells. This type of treatment can lower the amount of radiation damage to healthy tissue near a tumor.

Learn more about radiation therapy and its side effects at Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects.

Clinical trials

For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.

Treatment of localized liver cancer

Treatment of localized liver cancer may include:

• surveillance for lesions smaller than 1 centimeter
• partial hepatectomy (surgery to remove the part of the liver where cancer is found)
• liver transplant
• ablation of the tumor using:
  • radiofrequency ablation
  • microwave therapy
  • percutaneous ethanol injection
  • cryoablation
• radiation therapy

Treatment of locally advanced or metastatic liver cancer

Treatment of locally advanced or metastatic liver cancer may include:

• transarterial embolization (TAE) or transarterial chemoembolization (TACE) in people with locally advanced liver cancer
• bevacizumab, cabozantinib, lenvatinib, ramucirumab, regorafenib, or sorafenib
• atezolizumab with bevacizumab or cabozantinib, durvalumab with tremelimumab, nivolumab with ipilimumab, or pembrolizumab
• radiation therapy

Treatment of recurrent liver cancer

Treatment options for recurrent primary liver cancer may include:

• total hepatectomy (surgery to remove all of the liver) and liver transplant
• partial hepatectomy (surgery to remove the part of the liver where cancer is found)
• ablation therapy
• transarterial chemoembolization (TACE) and sorafenib as palliative therapy to relieve symptoms and improve quality of life