Treatment overview for primary liver cancer

Your treatment will be planned by a team of specialists called a multidisciplinary team (MDT). Treatment for primary liver cancer (HCC) depends on the extent of the cancer, how well your liver is working and your general health.

Possible treatments include:

  • Surgery – a surgeon operates to remove the cancer
  • Tumour ablation – a doctor applies heat or alcohol to the cancer cells to destroy them
  • Embolisation – a doctor blocks blood vessels close to the cancer to try to shrink it
  • Targeted therapy – a tablet called sorafenib may help to control advanced liver cancer
  • Chemotherapy – this may be used to try to control advanced liver cancer
  • Radiotherapy – this is sometimes used to treat HCC.

You and your doctor will decide on the best treatment for you. Your doctor will explain if treatment may be able to cure the cancer or if the aim is to help control the cancer and relieve symptoms. They will also explain the possible benefits and disadvantages of the treatment.

If you choose not to have treatment for HCC, you can still have other treatments to control symptoms.

Treatment overview

The treatment you have will usually depend on:

  • where the cancer is in the liver – there may be several areas of cancer in different parts of the liver
  • the size of the tumour or tumours
  • how many tumours there are
  • whether the cancer has spread outside the liver
  • whether any important blood vessels in the liver are affected
  • how well your liver is working
  • your general health.

Surgery may cure HCC. This may involve a liver transplant or an operation to remove part of the liver. But often surgery is not possible. This might be because the cancer is too advanced or the liver is too damaged to cope with surgery.

Some people may have tumour ablation. This is where a doctor applies heat or alcohol to the cancer cells to destroy them.

Chemoembolisation is when chemotherapy is put into the liver and the blood supply to the tumour is cut off. Doctors may recommend this treatment when the cancer is advanced in the liver but has not spread outside it. It may help to control the cancer and prolong your life. Another treatment called radioembolisation works in a similar way. It uses radiation instead of chemotherapy to destroy cancer cells.

Doctors may use a targeted therapy drug called sorafenib. This may be given if the cancer is advanced in the liver or has spread outside it. Sometimes chemotherapy may be used. It may control the cancer, prolong your life and reduce the symptoms. Radiotherapy may be used to relieve pain if the cancer has spread to a part of the body, such as the bones. Doctors are looking at newer treatments and different ways of giving existing treatments. Your specialist may talk to you about taking part in a research trial.

If you decide not to have treatment, there is a still a lot that can be done to control symptoms and support you. Your doctor can refer you to a team of doctors and nurses who specialise in controlling symptoms. This is called a palliative care team.

How treatment is planned

In most hospitals, a team of specialists will meet to discuss the best treatment for you. This multidisciplinary team (MDT) will include:

  • a hepatologist – a liver disease specialist
  • a surgeon who specialises in liver cancers
  • a medical oncologist – a doctor who specialises in giving chemotherapy
  • a clinical oncologist – a radiotherapy and chemotherapy specialist
  • an interventional radiologist – a doctor who uses imaging to help them give treatments such as ablation or embolisation
  • a nurse specialist
  • radiologists – who help to analyse x-rays and scans
  • pathologists – who advise on the type and spread of the cancer.

It may also include:

  • a palliative care doctor or nurse who specialises in symptom control
  • a dietitian
  • a physiotherapist
  • an occupational therapist (OT)
  • a psychologist or a counsellor.

After the meeting, your specialist doctor or nurse will talk to you about your treatment options. They will explain what each treatment involves and the possible side effects. You and your doctor can decide on the best treatment for you. You may also want to talk about it with your family or close friends.

If two treatments are likely to be equally helpful, your doctor may ask you to decide which one to have. Make sure you have enough information about the different options. You can then decide on the right treatment for you.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions before the meeting. You can then write down the answers you get next to the questions. You might want to take a family member or close friend along with you for support.

The benefits and disadvantages of treatment

Many people are frightened of the idea of having cancer treatments, particularly because of the possible side effects. However, side effects can usually be controlled with medicines. 

Treatment can be given for different reasons and the potential benefits will vary depending on your individual situation.

In people with early-stage liver cancer, surgery may be done with the aim of curing the cancer. Or treatments may be used to control the cancer and prolong your life.

If the cancer is advanced or has spread to other parts of the body, treatment may only be able to control it. It may prolong your life, improve your symptoms and give you a better quality of life. But for some people in this situation, the treatment will have no effect on the cancer and they will get the side effects without any of the benefit.

If you have been offered treatment that aims to cure the cancer, deciding whether to have it may not be difficult. But if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.

Making decisions about treatment in these circumstances is always difficult. You may need to talk to your doctor about whether you want to have treatment. If you choose not to have it, you can still be given supportive (palliative) care, with medicines to control any symptoms.

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