Treatment
Treatment of secondary liver cancer depends on multiple factors such as the type of the original tumor that has spread to the liver, how much of the liver is involved by cancer, whether the cancer has spread beyond the liver to other organs, and the patient's overall general health.
Surgery
If possible, liver resection is the treatment of choice. In a liver resection, the doctor removes the cancerous portion of the liver along with a margin of healthy tissue around it. However, a liver resection is not an option for all patients. If the cancer is very widespread (multiple tumors) in the liver and the doctor is not able to obtain negative margins or preserve an adequate amount of healthy liver, a resection is not an option. In some cases, chemotherapy is given before surgery (neoadjuvant chemotherapy) to try to shrink tumors enough to allow for resection in these patients.
Chemotherapy
For colorectal liver metastasis, patients will usually all get chemotherapy. This treatment could be delivered either before or after surgery or for after surgery. For metastasis from other tumor sites, surgery may be an option if the tumor responds to chemotherapy, and there is no evidence of disease outside of the liver. If resection is not an option, systemic chemotherapy is the treatment of choice. Systemic chemotherapy can shrink the tumors and prolong survival, but does not cure the disease. If the cancer is only in the liver, the doctor may sometimes recommend treatment with hepatic artery infusion, a treatment in which the chemotherapy medication is injected directly into the hepatic artery via catheter. This procedure delivers chemotherapy more directly to the tumor and reduces unnecessary side effects, but also has its own side effects. Hospitals may offer alternatives to this therapy due to potential side effects.
Hormone Therapy
In some cases, such as when breast cancer spreads to the liver, hormone therapy may be an effective treatment. These tumors grow more aggressively in the presence of certain hormones, so hormone therapy blocks the production of these hormones and prevents them from fueling tumor growth.
Targeted Therapy
Targeted therapy is a relatively new type of treatment that works in two ways. Some types of targeted therapy target proteins on the surface of cancer cells that cause the cancer to grow more aggressively. Other types attack the process of angiogenesis, which tumors use to create new blood vessels to support their growth. The doctor may also recommend treatment with certain targeted therapies that have been proven effective in treating the primary tumor that has spread to the liver. Others, such as immunotherapy target the patient's immune system to help in fighting the tumor.
Ablation
Ablation is a type of local treatment that destroys tumor cells using intense heat or cold. The doctor may recommend ablation techniques to destroy tumors in the liver. Ablation is minimally invasive, and can sometimes obliterate tumors which are otherwise surgically inoperable.
Radiation Therapy
The doctor may recommend palliative radiation therapy to control disease, to alleviate pain and to improve quality of life. Additionally, the doctor may recommend radioembolization, which combines radiation therapy with tumor embolization. In this procedure, small radioactive particles are injected into the hepatic artery, which supplies blood to the liver. These particles settle near the tumor and give off radiation for several days.
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 conducted mainly to access the safety of a drug, while later phase clinical trials are used to assess the efficacy of a drug. 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.
