Liver cancer (Primary)


Primary liver cancer treatment

Page last updated: August 2024

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There are many different types of treatment for hepatocellular carcinoma (HCC), which is the most common type of primary liver cancer. Treatment recommended will depend on a range of factors, including:

  • the size of the tumour
  • how far it has spread within the liver and the body
  • whether you have cirrhosis
  • if any major blood vessels are involved
  • your age and your general health.

A multidisciplinary team (MDT) may meet to discuss the best treatment options for you. Ask your doctor if your case has been discussed by an MDT. Treatments for HCC that affects only the liver include:

  • surgery – liver resection or liver transplant
  • tumour ablation – heat or alcohol is used to destroy the tumour
  • radiation therapy – stereotactic body radiation therapy (SBRT), also known as stereotactic ablative body radiation therapy (SABR), or selective internal radiation therapy (SIRT)
  • transarterial chemoembolisation (TACE) – chemotherapy drugs are delivered directly to the tumour via its blood supply.

If the cancer is advanced or has spread beyond the liver, you may be offered drug therapies such as immunotherapy or targeted therapy. Sometimes, if the liver is too damaged, you may be offered palliative treatment.

Before treatment begins, your treatment team may suggest that you exercise, eat a healthy diet, or speak to a counsellor about how you feel. If you smoke, you will be encouraged to stop.

Research shows that quitting smoking before surgery reduces the chance of complications. Preparing for treatment in this way – called 'prehabilitation' – may help your recovery.

Your guide to best cancer care

A lot can happen in a hurry when you’re diagnosed with cancer. The  guide to best cancer care for liver cancer can help you make sense of what should happen.

It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.

Read the guide

Surgery

Liver surgery aims to remove all the cancer from the body.

This may be done by removing the part of the liver affected by cancer (liver resection or partial hepatectomy) or by removing the whole liver and replacing it with a liver from a donor (liver transplant).

Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications. There are risks associated with any type of surgery.

A surgeon needs your agreement (consent) before performing the operation. Receiving relevant information about the benefits and risks of surgery before agreeing to it is called informed consent.

Liver resection

The aim of a liver resection is to remove all cancer from the liver, as well as a margin of healthy tissue.

A liver resection is usually performed in a specialist treatment centre. It is suitable for only a small number of people with liver cancer. The liver needs to repair itself after the surgery, so a resection is only an option when the liver is working well.

People with no or early cirrhosis may be considered for surgery, but it is unlikely that people with more advanced cirrhosis will be offered surgery. Surgery is also not suitable for people with ascites or when the cancer has spread to major blood vessels. 

Types of liver resection

Portal vein embolisation (PVE)

What to expect after surgery

 

Liver transplant

A liver transplant can be an effective treatment for some people with primary liver cancer. It involves removing the whole liver and replacing it with a healthy liver from another person (a donor).

However, liver transplants are suitable for only a small number of people.

Currently, all liver transplants in Australia are performed in public hospitals and there is no cost for in-hospital services. You will usually have to pay for any medicines you continue to take once you leave the hospital.

Transplant eligibility

Waiting for a liver transplant

What to expect after a transplant

 

Tumour ablation

For tumours smaller than 3 cm, you may be offered tumour ablation. This destroys the tumour without removing it and may be the best option if you cannot have surgery or are waiting for a transplant.

Ablation can be done in different ways depending on the size, location and shape of the tumour. Thermal ablation and alcohol injection are the most common methods used for liver cancer.

Cryotherapy, which uses freezing to destroy the tumour, is rarely used.

Thermal ablation

Alcohol injection

Radiation therapy

Primary liver cancer is sensitive to radiation but so are healthy liver cells. Two specialised radiation therapy techniques can deliver radiation directly to the tumour while limiting the damage to the healthy part of the liver.

These are called stereotactic body radiation therapy (SBRT) and selective internal radiation therapy (SIRT). SBRT may be suitable for people with early-stage cancer, while SIRT may be offered in more advanced cases.

Conventional external beam radiation therapy (EBRT) is also occasionally used as a palliative treatment to help manage symptoms. For example, short courses of EBRT can help to control pain caused by liver cancer that has spread to the bones.

Stereotactic body radiation therapy (SBRT)

Selective internal radiation therapy (SIRT)

“It helps to focus on what is happening now, what is actually known – not all the possibilities. One step at a time.” Sam

Transarterial chemoembolisation (TACE)

Liver tumours mostly get their blood supply from the hepatic artery. In transarterial chemoembolisation (TACE), chemotherapy is delivered directly to the tumour through this artery.

TACE is usually given to people who can’t have surgery or ablation for primary liver cancer. The procedure may be used to shrink the cancer or stop it growing while people are waiting for a liver transplant or a major liver resection. 

It is common to have a fever the day after the procedure, but this usually passes quickly. You may experience nausea and vomiting, or feel some pain, which can be controlled with medicines.

Some people feel tired or have flu-like symptoms for up to a week after the procedure.

“I’d like people with advanced cancer to know that there are a myriad of services. You only have to ask; you are not alone.” Pat

Drug therapies

Two types of drug therapies are available to treat primary liver cancer – immunotherapy and targeted therapy.

Drug therapies (sometimes called systemic therapies) can spread throughout the whole body to treat cancer cells wherever they may be, which can be helpful for cancer that has spread (metastatic cancer).

Drug treatment for advanced liver cancer is changing quickly and new treatments may become available in the near future. You may also be able to get new drugs through clinical trials.

Talk to your doctor about the latest developments and whether there are any suitable clinical trials for you.

Immunotherapy

Targeted therapy

 

Palliative treatment

If liver cancer is advanced when it is first diagnosed or returns after initial treatment, your doctor will discuss treatment options to help control the cancer’s spread and relieve symptoms.

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer when a cure is not possible. It is best thought of as supportive care.

Many people think that palliative treatment is for people at the end of their life, but it may help at any stage of advanced liver cancer. It is about living as long as possible in the most satisfying way you can.

Treatment may include radiation therapy, pain management, drainage of fluid or insertion of a stent in the bile duct to relieve jaundice.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, social and spiritual needs. The team also supports families and carers.

Learn more

Understanding Liver Cancer

Download our Understanding Liver Cancer booklet to learn more and find support.

Download now  Order for free

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