Treatment aims to eliminate cancer, slow cancer growth, improve patient survival or manage symptoms. The choice of treatment depends on several factors:
- The spread of cancer within the liver
- Whether the cancer has metastasized
- The patient’s overall condition and treatment preference
- The status of the remaining cancer-free area of the liver
This is the removal of the tumor (usually with some surrounding healthy tissue) during an operation. It is used particularly in patients with a small tumor (<5 cm) solely in the liver.
Two types of surgery are used to treat hepatocellular carcinoma (HCC):
This is when the portion of the liver with the cancer is resected. The remaining, healthy section of liver then takes over the functions of the entire organ. It is even possible that the liver may regrow to its normal size within weeks. Regardless of tumour size, this may not be an option if the patient has advanced cirrhosis.
The side effects may include pain, weakness, fatigue, bleeding, infection and liver failure.
Patients must fulfil very specific criteria in terms of tumor size and number to qualify for this. Due to the limited number of donor livers available transplantation is not always possible.
After a transplant, rejection of the new liver is a real likelihood therefore the patient must take medication to prevent this.
Percutaneous ethanol injection
This involves the injection of alcohol directly into the tumor in a generally simple and safe procedure. It is particularly effective in destroying a small tumor (<3 cm). Side effects include fever and pain after the procedure.
Radio waves or laser light of high intensity are passed through a needle which is inserted into the tumour. This conveys enough heat to kill the cancer cells. This option has largely replaced ethanol injection.
This involves the injection of drugs (in an oily immersion) into the hepatic artery supplying the tumour with blood. The drug-oil solution maintains the chemotherapy in the liver for long enough to destroy the cancer cells.
This is the primary treatment for HCC, but may also be used to slow tumor growth as patients await a liver transplantation.
This employs high-energy radiation to destroy cancer cells. Measures are taken to protect the other organs from radiation exposure and the treatment side effects (e.g. damage to the stomach and lungs).
There are two types of radiation therapy used to address cholangiocarcinoma and HCC:
Stereotactic body radiation therapy (SBRT)
This treatment involves delivering high doses of radiation to a tumor (£ 5cm) while limiting the amount that reaches and damages healthy tissues.
This involves strategically placing radioactive beads into the small blood vessels responsible for supplying the tumor with blood. When they become trapped in these vessels, they also deliver radiation directly into the tumor to halt its growth.
This therapy addresses the specific and individual genes that contribute to the growth and survival of different forms of cancers. This allows the design of effective, more personalized treatments.
Anti-angiogenesis drugs are the most common example of targeted therapy for HCC. These drugs act by inhibiting angiogenesis (formation of new blood vessels) to essentially “starve” the tumor of nutrition.
For example, Sorafenib is a pill taken as a treatment for advanced HCC that cannot be entirely removed by surgery. The side effects of this include diarrhea and certain skin problems.
The use of chemical substances to stop the growth, division and spread of cancer cells.
Systemic chemotherapy involves administering drugs (one or in combination) via the bloodstream to reach widespread cancer cells. Delivery is typically through an intravenous tube (or given orally) in a specific number of cycles given over a set period of time. This is not commonly used for HCC.
The side effects vary with individual and dosage but include nausea, vomiting, hair loss, loss of appetite, fatigue, low blood cell count, bleeding or bruising after superficial cuts or injuries and numbness and tingling of extremities. These usually stop once treatment is concluded.
This aims to reduce symptoms and side effects of treatment to improve quality of life. Palliative care can be a combination of medication, dietary changes, relaxation techniques, emotional support, and other therapies.