What are the treatment options for primary cancer of the liver?

The main treatments used for primary liver cancer are surgery and chemotherapy. Other techniques are sometimes used. The treatment advised in each case depends on various factors such as:

• The exact site of the primary tumour in the liver.
• The stage of the cancer (how large the cancer is and whether it has spread).
• Your general health. In particular, the general state of your liver and liver function (many people with primary liver cancer also have poor liver function due to cirrhosis).

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the possible treatment options for your type of cancer.

You should also discuss with your specialist the aims of treatment. For example:

• In some cases, treatment aims to cure the cancer. The best chance of a cure for primary liver cancer is when it is diagnosed and treated at an early stage. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.)
• In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it may be possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
• In some cases, treatment aims to ease symptoms ('palliative treatment'). For example, if a cancer is advanced then you may require painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer which may ease symptoms such as pain.

Surgery
Surgery which aims to cure the cancer is an option in some cases. If the cancer is small, has not spread outside the liver, and the rest of the liver is healthy, then it may be possible to cut out the part of the liver which contains the cancer. Healthy liver tissue will 'regrow' to its full size within a few weeks if a section of liver is cut out. However, this operation is not suitable if your liver is damaged with severe cirrhosis (which is the case in many people with primary liver cancer).

A liver transplant is another option, but again only suitable for a small number of cases.

Surgery also has a role in palliative care. For example, if jaundice is severe, it may be possible to relieve the blockage of the bile by inserting a 'stent'. This is a narrow tube which allows the bile to drain into the gut. Another example is to ease ascites (fluid in the abdomen) if it is severe. The ascites can be drained by inserting a tube through the wall of the abdomen.

Chemotherapy
Chemotherapy is a treatment which uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. It is not likely to be curative for primary liver cancer, but may shrink the tumour down to slow the progression of the disease.

Other treatments
Various other treatment techniques are sometimes used. For example:

• Alcohol ablation. Ablation means 'to destroy'. For this treatment alcohol is injected into the tumour. The alcohol kills cancer cells.
• Radiofrequency ablation. For this treatment a needle is pushed into the tumour. High intensity radio waves or laser light is then passed through the needle. This heats the cancer cells and kills them.
• Cryotherapy. For this treatment a small metal object filled with liquid nitrogen is placed into the tumour. The liquid nitrogen makes it very cold which destroys cancer cells.
• Chemoembolisation. For this treatment, drugs used for chemotherapy are mixed with another oily chemical. The mixture is then injected into branches of the liver artery (hepatic artery) which are supplying the tumour with blood. The oily chemical helps to 'hold' the chemotherapy drugs longer in the liver, and make them more effective in killing cancer cells.
• Radiotherapy. This is a treatment which uses high energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Radiotherapy is not often used for primary liver cancers apart form the uncommon cholangiocarcinoma type of cancer.

What is the prognosis (outlook)?

Overall, the outlook is poor. Many people who develop primary liver cancer are already in poor health with cirrhosis. The best chance of a cure is with surgery when the cancer is small, has not spread from the liver, and the rest of your liver is relatively healthy. However, this situation only occurs in a minority of cases. The various other treatments described above may delay the progression of the disease, but are not often curative.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

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