Treatment and Prevention
As with most cancers, there are three forms of treatment available for liver
cancer: surgery, chemotherapy, and radiotherapy. The treatments can be combined
with one another.
For localized resectable cancer (small T number, N0, M0), the treatment
is usually surgery. This involves removing the tumor and, perhaps, some surrounding
tissue. The liver is a unique organ in that it can regenerate its cells and
continue to function as before.
The cancer can also be destroyed in place through cryosurgery or ethanol
ablation. For cryosurgery, the surgeon uses a metal probe to freeze the
cancer cells. A small incision is made and the probe, which has liquid nitrogen
circulating in the tip, does the freezing. In ethanol ablation, the surgeon
injects alcohol directly into the tumor, either through the skin or during
a surgical procedure..
Removal of the entire liver isn't an option, as the liver is essential to survival.
In the past, those with cancer weren't candidates for liver transplants; however,
surgeons are now learning that some people with early liver cancer can benefit
from a transplant. With a successful transplant and proper medical care, the
recipient can go on to lead a healthy life.
For localized unresectable cancer (higher T number, N0, M0), the location
of the tumor doesn't allow for surgical removal. This may be because it's situated
in a very sensitive area or because it is affecting too much of the liver. The
treatment options here are chemotherapy, liver transplant, radiation therapy,
radiofrequency ablation or ethanol ablation.
Chemotherapy uses medications to kill the cancer cells. The medications are usually given intravenously
(injected directly into the blood), but some are now available in a pill form
to be taken orally. One difficulty with treating liver cancer is that many medications
are metabolized (broken down) in the liver, so the options may be limited.
Chemotherapy medications circulate throughout the body, so the side effects, although
temporary, can affect many different areas of the body. They include:
- nausea and vomiting
- hair loss
- fatigue
- diarrhea
- chills
- shortness of breath
- coughing
- mouth sores
Another form of chemotherapy, called hepatic artery infusion, allows
the medications to go directly to the liver. A small pump is placed directly under
the skin and delivers the medications directly into the artery leading to the liver.
This type of treatment decreases the side effects, since the medications are delivered
in a more focused manner and don't spread as much through the rest of the body. Researchers haven't found that this type of treatment is more effective
in treating liver cancer than the normal way of giving chemotherapy, but it
does seem to increase the quality of life among those with liver cancer.
A procedure called chemoembolization might considered be for a tumor
that can't be removed surgically. Material that has been saturated with chemotherapy
medications is injected into the blood vessels that supply nutrients to the tumors.
By cutting off their fuel, it kills the cancer cells.
Radiation therapy (radiotherapy) is an external treatment that
kills the cancer cells. It's aimed directly at the tumors in an effort to shrink
them. In some cases, radiotherapy might be done before surgery to shrink the
tumors, making them easier to remove. Radiotherapy isn't used very often to
treat liver cancer, as the tumors tend not to respond to radiation and the
liver itself is very sensitive to it.
For people treated with radiotherapy, there are several possible side effects.
They include:
- fatigue
- red, dry skin at the radiation site
- nausea and vomiting
- decreased appetite
- diarrhea
Advanced liver cancer (N1 and/or M1) is more difficult to treat, as it has
spread to other parts of the body. In these cases, chemotherapy and radiotherapy might be options.
People who have recurrent liver cancer will have their treatment based on what
has already been done and how far the cancer has developed.
Liver cancer can't be prevented, but with understanding of the risk factors
involved, it might be easier to detect in its early stages. People who
fall in the high-risk groups, such as those who have hepatitis or cirrhosis,
should be screened regularly with either ultrasounds or blood tests. Blood tests
can show the level of liver enzymes, which tells doctors how well the liver
is working.