Liver Cancer Treatments

When you are able to provide patients a disease-free advantage ... it is extremely gratifying.”
GAGANDEEP SINGH
M.D., HEAD OF LIVER AND PANCREATIC SURGERY

Liver cancer treatment options

City of Hope has one of the most renowned liver cancer programs in the United States, with a multidisciplinary team of medical experts across different fields — including surgery, radiation oncology, medical oncology and supportive care medicine.

Members of our liver cancer team meet twice weekly to review patient cases, bringing a variety of clinical perspectives and experience to the development of an individualized treatment plan. The team also participates in a weekly meeting to share clinical trial results, review information from surgical pathology reports and plan future research studies.

Our physicians are also active members in many collaborations and cooperative groups, and have led or participated in most national clinical trials for detecting, treating and preventing liver cancer. This dedication to research also ensures our patients have access to the most promising and leading-edge liver cancer therapies.

Learn more about our liver cancer treatment options below:

Surgery

Surgery is the primary treatment for liver cancer. It can be curative for early stage liver cancer patients and can also improve survival outcomes and reduce discomfort for advanced liver cancer patients.

  • The procedure can involve removing the tumor from the body or destroying the tumor while it’s still in the body (ablation) or halt its growth by cutting off its blood supply (embolization).
  • The liver is one of two organs in the human body that has the capacity to regenerate. Up to 80 percent of the liver can be surgically removed and, within several weeks, it will entirely rebuild itself. If one lobe - and its associated blood vessels - is surgically removed, the remaining lobe will compensate for the loss.
  • Our surgeons routinely use a new technique called preoperative portal vein embolization, which redirects the blood supply to the healthy portion of the liver to stimulate cell growth before surgery.
  • Our doctors also use liver-sparing surgical techniques that leave more of the healthy liver intact, reducing the need for regeneration and the possibility of complications.
  • The expertise of City of Hope’s surgeons also means that they can treat liver tumors that are considered inoperable elsewhere. This is done through advanced procedures that can navigate around sensitive areas (such as major blood vessels) and working with radiation and medical oncologists, who can shrink the tumor to down to an operable size and shape with radiation and drug therapies.

World-renowned surgeons

Our liver surgeons have performed thousands of liver tumor operations and we have one of the most experienced liver surgery teams in the nation. Our experience and leadership in this field has been demonstrated with published findings showing the following benefits compared to hospitals that do not perform a high number of liver surgeries.

  • Lower rate of complications
  • Better clinical and survival outcomes
  • Enhanced quality of life

Our experience also means we can surgically treat a greater range of liver cancer patients, including patients who may be deemed inoperable elsewhere due to advanced disease, older age or other health conditions.

Additional highlights of our liver cancer surgery program

  • When possible, minimally invasive and robotically assisted tumor removals, which reduces discomfort, blood loss, hospital stay and recovery time compared to traditional open procedures.
  • Therapies to stimulate liver regeneration that allow our surgeons to remove a greater portion of suspicious liver tissue to prevent cancer recurrence.
  • For patients with secondary liver cancers (e.g., cancer originating elsewhere but have spread to the liver), our surgery teams can coordinate so that we can remove both the primary tumor and the liver metastases in a single operation. This simultaneous removal results in less blood loss and shorter hospital stays compared to staging the removal in two separate operations.
  • Liver transplant - patients with liver tumors that are small in size and number, have not spread to nearby blood vessels, and have cirrhosis or other liver conditions, may be eligible for liver transplantation at another medical center. Our liver cancer team can identify which patients may benefit from transplantation and routinely coordinates liver transplantation at other area hospitals.

 

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Ablation and Embolization

Ablation and embolization are minimally invasive procedures using small tubes and needles to deliver cancer therapy directly to the tumor. These needles and probes are inserted through the skin or a blood vessel and carefully guided to the cancer site using detailed imaging technology.

This therapy can either kill the liver tumor outright (ablation) or block its blood supply (embolization). The specific therapies offered at City of Hope include:

  • Chemical ablation (using ethanol or acetic acid to kill tumor cells)
  • Thermoablation (using extreme heat or cold to kill tumor cells)
  • Chemoembolization (blocking a blood vessel with chemotherapy-coated beads)
  • Radioembolzation (blocking a blood vessel with radioactive beads)

Ablation and embolization are viable options for patients who are current ineligible for surgery. In some cases, these therapies can shrink the tumor enough to make them operable.

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Drug Therapy

Drug therapy may be given to patients to fight liver cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

  • Immunotherapy, which stimulates the patient’s own immune system to recognize and attack liver cancer cells.
  • Biologic therapy, which refers to a host of new drugs that stop tumor cells from replicating and/or disrupt a tumor’s blood supply.
  • Targeted therapy, which selectively attacks liver cancer cells based on specific characteristics.
  • Chemotherapy, which targets rapidly dividing cells, including liver cancer cells.

The drug or drug combination used depends on the type and stage of liver cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope patients may also be eligible for new, promising drugs through our clinical trials program.


Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site.

Radiation can treat tumors that cannot be removed by surgery (sometimes shrinking them enough to be operable) and can be used to relieve pain and other liver cancer symptoms.

City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

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Follow-up care

Because cancer of the liver is difficult to control, regular follow-up care after the initial course of treatment  including periodic imaging, liver function, and blood tests  is very important. You should also never hesitate to let members of your care team know about pain or any symptoms, changes, or problems that occur after treatment. Follow-up care can be arranged to be ongoing at City of Hope or arranged in partnership with you primary care physicians.

There is a high incidence of recurrent liver cancer, even after successful treatment. Patients who have been treated for liver cancer should see their surgeon, oncologist, or other doctors for regular surveillance with imaging tests such as ultrasound, CT or MRI to determine whether the cancer has returned.

Hepatitis treatment and liver cancer surveillance

Some patients with liver cancer have chronic hepatitis B or C.  These viruses cause chronic inflammation and scarring in the liver, which can lead to cirrhosis and liver cancer. Chronic hepatitis B and C can be controlled with antiviral medications. Treatment with antiviral medications is often recommended in combination with treatment for liver cancer.

Nutrition

Patients with liver cancer often have cirrhosis or associated diabetes. Dietary counseling can often help prevent other metabolic problems or symptoms of liver insufficiency. Patients should minimize or eliminate alcohol use and avoid intensive treatment with herbal remedies. City of Hope’s Supportive Care Medicine Program provides ongoing access to nutritional information and other quality-of-life support.