The type of treatment for patients with liver cancer will depend on its stage (ie. its size and whether it has spread to other parts of the body) and the patient’s general health. The main treatments used are surgery, tumour ablation (removal), chemotherapy, targeted cancer therapy, and radiotherapy.
Surgery has a chance of treating the cancer and is therefore the treatment of choice for patients with early stage liver cancer. If only certain parts of the liver are affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called a liver resection.
Another form of surgery is a liver transplant. This involves the removal of the entire liver which is replaced with a healthy, donated liver. Such a major operation may be considered when the cancer is in the liver only, if a donor liver is available, and if the medical team believes the cancer is likely to be eliminated by surgery. A healthy liver is capable of growing back, so a living donor liver transplant can also be performed where part of a healthy donor’s liver is removed and transplanted to the patient. In this case, both the remaining liver in the donor and the transplanted liver can grow back fully if the procedure is successful. Anti-rejection drugs (immunosuppressants) will be needed to prevent organ rejection after a liver transplant.
Tumour Ablation
Tumour ablation (removal) aims to destroy primary liver cancer cells using either heat (radiofrequency ablation – RFA) or alcohol (percutaneous ethanol injection – PEI). This procedure is usually done in the scanning department so that the ultrasound or computed tomography (CT) can help the doctor with guiding a needle into the liver cancer. A local anaesthetic will be given at the start of the procedure. RFA treatment uses laser light or radio waves passed through the needle to destroy cancer cells by heating them to a very high temperature. PEI treatment uses alcohol injected through the needle into the cancer to destroy the cancer cells. Tumour ablation may sometimes be repeated if the tumour grows again.
Chemotherapy
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing and growing further. It can help to control symptoms by shrinking the cancer and slowing its development. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets (orally). Chemotherapy may also be given as part of a treatment called chemoembolisation. This involves the injection of chemotherapy drugs directly into the liver cancer, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation). Not everyone is suitable for chemotherapy as it can only be given if the liver function remains suitably well.
Targeted Cancer Therapy
Targeted cancer therapy uses drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in cancer growth and development, eg. a targeted drug called sorafenib may be used to treat patients with advanced liver cancer. This drug targets cancers by stopping them from growing their own blood vessels. As cancer cells need a blood supply to receive nutrients and oxygen, this may therefore limit the cancer’s ability to grow. It has been demonstrated in 2 large clinical studies to lengthen survival time in patients with advanced liver cancer, compared with supportive care alone. Sorafenib’s side effects include diarrhoea, tiredness, and high blood pressure.
Radiotherapy
Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing further. External radiotherapy uses a machine outside the body to direct radiation to the cancer. Such treatment is not often used to treat liver cancer because the liver cannot take very high doses of radiation. It may, however, be used to relieve pain, eg. in patients whose cancer has spread to the bone. Another method is internal radiation, which involves a radioactive substance implanted selectively to the cancer through the hepatic artery, a major blood vessel that carries blood to the liver.
Can Liver Cancer be Prevented?
Yes, there are several things that can prevent liver cancer, these include:
1. Vaccinate against the hepatitis B virus
2. Avoid drinking too much alcohol, which causes alcoholic fatty liver disease – a disease that can develop into liver cancer
3. Avoid eating heavy meat and animal fat, and mouldy peanuts and grains
4. Go for regular screenings if considered part of the high-risk group