Partial hepatectomy

This operation removes only the cancerous area of the liver, leaving the remaining part of the liver. In order to have a partial hepatectomy, the patient must have enough healthy liver to function on its own. Patients with cirrhosis often cannot undergo the procedure because the damage to their livers is too great that they do not have enough remaining normal liver to get over the surgical procedure. Surgery is also not an option for patients who have a tumor close to the liver’s main arteries, veins or bile ducts. A partial hepatectomy is considered the best treatment option available for patients with localized resectable cancer.

Liver transplantation

In this procedure, the doctor removes the entire liver (total hepatectomy) and replaces the diseased liver with a healthy liver from an organ donor.

Cryosurgery

Cryosurgery attacks tumors by freezing them with a very cold metal probe. Using ultrasound, a probe is directed into the tumor whereupon an exceedingly cold substance, such as liquid nitrogen, is inserted to cool the metal probe. The extreme cold from the probe then kills the cancer cells.

Radiofrequency and microwave ablation

Radiofrequency ablation (RFA) and microwave ablation use high-energy radio waves to attack tumors. A thin, needle-like probe is placed into the tumor and releases radio waves. This current then destroys the tumor with extreme heat. These techniques are performed by an interventional radiologist percutaneously.

Chemoembolization

Small particles block the flow of blood in order to keep the drug inside the liver cancer for a longer period of time. Very few healthy liver cells are damaged in this procedure. Most liver tumors get their blood supply from the hepatic artery, and healthy liver cells are supplied by the portal vein. Also, the hepatic artery is blocked at the site of the tumor, so only the tumor itself is affected. The healthy liver continues to receive its blood and nutrients from the hepatic portal vein. Hepatic artery embolization without chemotherapy drugs is also performed to block arterial flow which feeds liver cancer.

Radioembolization

The doctor may also recommend a newer procedure called radioembolization, which combines radiation therapy with tumor embolization. In this procedure, the small radioactive particles that are selectively injected into the hepatic artery settle near the tumor and kills the tumor cells through the nearby radiation.

Hepatic artery infusion

In this procedure, the doctor uses a catheter to inject chemotherapy drugs directly into the hepatic artery. This procedure delivers chemotherapy more directly to the tumor and reduces unnecessary side effects. This procedure is mostly done in Asia. In North America, radioembolization and chemoembolization are the most frequent treatments for patients with localized disease.

Radiation Therapy

Radiation therapy uses powerful radiation waves to shrink or kill an existing tumor. External radiation directs strong beams of energy at the tumor from outside the body. Internal radiation inserts radioactive substances into the body via needles or catheters.

Proton beam radiation therapy

Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.

• Please see Understanding Proton Therapy to learn more.

Immunotherapy

Cancer immunotherapy is a type of treatment that harnesses the patient’s immune system to attack and destroy tumor cells. The immune system has immune checkpoints that prevent it from attacking normal cells in the body. Cancer cells can express a lot of these checkpoints on their cell surfaces to prevent the immune system from recognizing and attacking cancer cells.

Immune therapy drugs can bind to the immune checkpoints PD-1 and CTLA-4 on immune cells, allowing the immune system to “see” the cancer cells again.

Chemotherapy

Chemotherapy uses cancer-killing drugs that travel through the bloodstream and destroy any cancer cells they encounter. Chemotherapy is the best treatment option for patients whose tumors cannot be removed by surgery. Chemotherapy is usually injected into the veins or taken orally. Targeted therapy is a type of chemotherapy that attacks specific target proteins on the surface of cancer cells that cause the cancer to grow more aggressively. One group of targeted therapy drugs for HCC are anti-angiogenic drugs. Other types attack the process of angiogenesis, which is when tumors stimulate the growth of new blood vessels to support their growth. Anti-angiogenetic drugs work by stopping from tumors from growing their own blood vessels. This can slow the growth of the tumor or sometimes shrink it. Targeted therapy can be given with immunotherapy in HCC.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. Clinical trials have led to many advances in medicine and in our ability to treat liver cancer.