While the preferred treatment is surgical removal of the cancer, many people are not candidates for surgery due to the extent of their disease and/or poor baseline liver health. Besides surgery, other treatment options include liver transplant, ablation therapy, embolization therapy, and prescription medications like targeted therapy, chemotherapy, and immunotherapy.
Surgery
Surgical removal of liver cancer is the treatment of choice. The challenge with surgery, however, is that most people with liver cancer also have cirrhosis from long-term liver disease.
With limited liver function from cirrhosis (the liver is so scarred), removing even a small part of liver tissue along with the cancer may render a liver functionally inadequate. Moreover, many liver cancers cannot be properly removed because they are too large and/or have spread outside the liver.
Evaluation
In order to access whether or not a person is a good surgical candidate, a healthcare provider will order an imaging test (like a CT scan or MRI) to evaluate the extent of the cancer, as well as liver function blood tests.
If you or a loved one is undergoing liver cancer surgery, it’s imperative you review all the risks and possible side effects with your surgeon. In addition, do not be afraid to ask questions and inquire about your surgeon’s experience.
Possible Side Effects
Surgical removal of liver cancer is a major surgery, especially since the liver is rich in blood vessels. This makes bleeding during surgery a major concern.
There was an error. Please try again.
Other potential side effects of surgery include:
Infection Blood clots Complications related to anesthesia Pneumonia
Your medical team will monitor you in order to minimize these risks, and provide instructions for ways you can minimize risk of complications as well.
Liver Transplant
Besides surgery, undergoing a liver transplant is another potentially curable treatment option, with the added benefit of treating not only the cancer but the cirrhosis, too. During a liver transplant, a transplant surgeon removes the diseased liver and replaces it with a healthy one from another person.
A healthcare provider may recommend a liver transplant if a liver tumor(s) is small or if surgery is not a possibility due to an unhealthy liver.
Possible Side Effects
In addition to the possible side effects associated with liver surgery (bleeding, infection, blood clots, anesthesia complications, and pneumonia), there are potential side effects linked to the medications a person needs to take after the transplant.
These immune-suppressing medications prevent a person from rejecting their new liver. Because they suppress your immune system, though, people are prone to infections.
Other potential side effects of immune-suppressing drugs include:
High blood pressureHigh cholesterolKidney problemsDiabetesBone weakening (called osteoporosis)
Non-Surgical Procedures
For people with liver cancer who are not surgical candidates, ablation and/or embolization therapy may be a treatment option. These therapies shrink and possibly destroy liver tumors.
Ablation Therapy
Ablation therapy is a non-surgical means of killing cancer cells and is the most frequently utilized therapy in liver cancer care. This procedure entails placing a needle or probe directly into a liver tumor and using various means to kill the cells.
The types of ablation therapy are named based on the means used to destroy the cancer cells:
Radiofrequency ablation (RFA): High-energy radio waves heat and kill the cancer cellsPercutaneous ethanol (alcohol) ablation: Alcohol is injected into the cancer cellsCryotherapy: Very cold gases are passed through the tumor to freeze the cancer cellsMicrowave ablation: Heat from microwaves is transmitted into the cancer cells
As with any procedure, there are risks and potential side effects to undergoing ablation. Some of these include:
Bleeding and bruising at the skin site where the needle or probe is insertedDamage to blood vessels in the liver or the surrounding liver tissue if the needle or probe is improperly placedInfection, including liver abscessDamage to the bile duct or other organsTumor seeding (a rare complication in which cancer cells are dispersed along the tract of the needle)
Embolization Therapy
During embolization, the blood supply to the liver cancer is blocked off so the cancer is “starved” and cannot grow. This treatment option may be used for liver tumors that are large and/or cannot be removed surgically.
Sometimes embolization is combined with chemotherapy (called chemoembolization) or radiation (radioembolization).
Prescriptions
Prescription medications are used to treat advanced or late-stage liver cancer. Targeted therapies are first-line therapy for treating advanced liver cancer, followed by chemotherapy or immunotherapy as a second-line option.
Targeted Therapies
Targeted drugs work by interfering with substances needed for cancer to grow. An approved first-line therapy for treating un-resectable liver cancer (meaning liver cancer that cannot be removed surgically) is Nexavar (sorafenib), which is a targeted drug that blocks a liver tumor from making new blood vessels.
Common side effects of Nexavar include:
FatigueRashLoss of appetiteDiarrheaHigh blood pressureHand-foot reaction
For people who cannot tolerate Nexavar, or as an alternative first-line therapy, a similar drug called Lenvima (lenvatinib) may be considered.
The most common side effects of Lenvima are:
Administration (FDA) approved Tecentriq (atezolizumab) and Avastin (bevacizumab) as an initial treatment for people with liver cancer that has spread or that can’t be treated with surgery. In the study that led to the approval, called IMbrave150, liver cancer patients treated with atezolizumab and bevacizumab lived substantially longer than those treated with Nexavar. They also lived longer without their cancer getting worse.
High blood pressureDiarrheaDecreased appetiteWeight lossFatigue
Another targeted drug Stivarga (regorafenib) blocks proteins that help liver cancer cells grow. This drug is currently used as a second-line therapy (meaning if Nexavar or Lenvima stop working).
Common side effects include:
FatigueLoss of appetite and weight lossRash on hands and feetHigh blood pressureFever and infectionsDiarrheaBelly pain
Chemotherapy
Chemotherapies are drugs that kill cancer cells. While “chemo” is generally taken by mouth or through a vein, in the case of liver cancer, it may be administered directly into the liver through the hepatic artery (called hepatic artery infusion).
Depending on the type and dose of chemotherapy given, a person may experience a range of possible side effects like:
Loss of hairMouth soresNausea, vomiting, and/or diarrheaWeight loss from a decrease in appetite
Since chemo drugs target rapidly dividing cells (cancer cells grow quickly), cells in a person’s bone marrow are often destroyed. This may lead to symptoms like easy bruising and bleeding, as well as fatigue and a high risk of infection.
Immunotherapy
Immunotherapy is a very exciting, evolving treatment option that has changed the face of cancer care. The premise behind immunotherapy is that it stimulates a person’s own immune system to attack cancer cells.
For liver cancer, the immunotherapy drug Opdivo (nivolumab) works by blocking an immune checkpoint protein called programmed death 1 (PD-1). This protein is deceitfully made by cancer cells to prevent a person’s immune system from recognizing it as foreign. So, by blocking PD-1, cancer can then be recognized and attacked.
Opdivo is given through the vein, every two weeks. Potential side effects include:
Fatigue or weaknessFeverCoughNausea and loss of appetiteItching and skin rashMuscle or joint painConstipation or diarrhea
More serious side effects include a reaction to the infusion (similar to an allergic reaction) or an autoimmune reaction, in which a person’s own immune system begins attacking healthy organs (for example, the lungs).
Complementary Medicine
Before using any herb or food, be sure to let your healthcare provider know. This will help prevent any unwanted side effects and interactions.
Sho-saiko-to
One herbal drug called Sho-saiko-to (also called Xiao Chai Hu Tang), which is a mixture of seven botanicals, including ginseng, ginger, and licorice, has been used to treat chronic hepatitis and cirrhosis.
Some research suggests that this herbal drug may also help suppress the development of liver cancer in people with cirrhosis, although its precise mechanism of action is unclear.
Holy Basil
Another herb called Ocimum sanctum L or “Holy Basil” is a plant that contains phytochemicals that promote liver health. It also possesses anti-cancer properties. This green vegetable is sometimes used in Thai cuisines. It has no known side effects.
Milk Thistle
Silymarin (Silybum marianum), also called milk thistle, is used in some countries (like Germany) as a supportive treatment for chronic liver disease. It’s also believed to have anti-cancer properties and has a good safety profile, although it may cause an allergic reaction or mild digestive symptoms.
Natural Foods
Besides herbs, natural foods may also help protect against liver cancer. Coffee is a rich source of antioxidants and is linked to a reduced risk of both cirrhosis and liver cancer. However, there is no scientific evidence that increasing your current coffee consumption (or starting to drink coffee if you never have) is beneficial.
