There are many different types of treatments for primary liver cancer in adults. Some treatments are standard therapies (those currently in clinical use), and some are being studied in clinical trials.
A therapeutic clinical trial is a research method designed to help improve an existing treatment or discover a new treatment for a new cancer. When a clinical trial shows that a new treatment is better than the standard treatment, the new treatment has the potential to become the standard treatment. Some patients may want to participate in a clinical trial, but some clinical trials are only open to patients who have not yet started treatment.
Patients with liver cancer are treated by a team of liver cancer specialists, who are supervised by a medical oncologist (a doctor who specializes in cancer treatment). When necessary, the medical oncologist will refer patients to other medical professionals trained in the treatment of liver cancer, which may include:
- hepatologists who specialize in liver disease
- Surgeon oncologists
- Organ transplant surgeons
- Radiation oncologists
- Interventional radiologists (specialists who use imaging and the smallest possible incisions to diagnose and treat disease)
- Pathologists
Standard treatment measures
Monitoring
Monitoring of cancerous lesions less than 1 cm detected at screening, usually every 3 months.
Surgery
Surgery refers to partial hepatectomy (surgical removal of the part of the liver where the cancer occurred), where a wedge of tissue, the entire lobe or a larger area of the liver, and some surrounding healthy tissue is removed. The function of the liver is maintained by the remaining liver tissue, with the possibility of regeneration.
Liver transplantation
Liver transplantation (liver transplant) is the removal of the entire liver and implantation of a donor healthy liver. The conditions for a liver transplant are that the lesion is confined to the liver and that there is an available donor liver. If the patient needs to wait for a donor liver, other treatments may be given as needed.
Ablation therapy
Ablation therapy eliminates or destroys cancer tissue. There are many different types of ablation therapy that can be used to treat liver cancer:
- Radiofrequency ablation: A special needle is used to reach the tumor directly through the skin or through an incision in the abdomen, using high-energy electromagnetic waves to heat the needle and the tumor to kill the cancer cells.
- Microwave therapy (microwave therapy): This therapy exposes tumors to the high temperatures produced by microwaves, which can destroy and kill cancer cells or make them more sensitive to radiation and certain anti-cancer drugs.
- Percutaneous ethanol injection: This therapy uses a small needle to inject ethanol (pure alcohol) directly into the tumor to kill the cancer cells, and the treatment may need to be supplemented with other treatments. Local anesthesia is usually given during treatment, and general anesthesia may be given if the patient has multiple tumors in the liver.
- Cryoablation: This type of treatment uses an instrument to freeze and destroy the cancer cells.
- Electroporation therapy: This therapy, in which electrodes are placed in the tumor to send electrical pulses to kill cancer cells, is still in clinical trials.
.
Embolysis therapy
Embolization therapy is a treatment for cancer that uses substances to block or reduce the flow of blood through the hepatic artery to the tumor. When tumors cannot get the oxygen and nutrients they need, they cannot continue to grow. Embolization therapy is used for patients who cannot have their tumors removed by surgery or ablation therapy and whose tumors have not yet spread outside the liver.
The blood supply to the liver comes from the portal vein and the hepatic artery, with blood from the portal vein usually going to healthy liver tissue and blood from the hepatic artery usually going to the tumor. After the hepatic artery is blocked by embolization, the healthy liver tissue continues to receive blood from the portal vein.
There are two main types of embolization therapy:
- Transarterial embolization (TAE): A small incision is made in the medial thigh and a catheter (thin hose) is inserted up the arterial vessel and placed into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
- Transcatheter arterial chemoembolization (TACE): This treatment is similar to TAE, except that anticancer drugs are given at the same time, either by attaching them to microspheres and injecting them into the hepatic artery, or by injecting them through a catheter into the hepatic artery and then injecting a substance to block the hepatic artery. Most of the anti-cancer drugs are distributed centrally near the tumor, with only a small amount reaching the rest of the body. This type of therapy is also known as chemoembolization.
Targeted therapies
Targeted therapy is a treatment that uses a drug or other substance to identify and attack specific cancer cells without harming normal cells. Targeted therapy for adult liver cancer may use drugs that stop cells from dividing and prevent new blood vessels from growing in the tumor.
Radiation therapy
Radiation therapy (radiotherapy) is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are different forms of radiation therapy:
- external radiation therapy (ERT): Treatment using an external machine that sends radiation to the area where the tumor is growing.
- conformal radiation therapy: uses a computer to create a three-dimensional image of the tumor so that the doctor can deliver the highest possible dose of radiation to the tumor while preventing damage to normal tissue.
- STEREOTACTIC BODY RADIATION THERAPY: Special equipment is used to position the patient and deliver radiation directly to the tumor. The total radiation dose is divided into several smaller doses and given in fractions over several days. This type of radiation therapy helps prevent damage to normal tissue and is still in clinical trials.
- Porton beam radiation therapy: High-energy radiation therapy that uses a stream of protons (small, positively charged particles of matter) to kill tumor cells. This type of radiation therapy is still in clinical trials.
- Internal radiation therapy (IRT): Uses radioactive material sealed in a needle, seed, wire, or catheter that is placed directly at or near the tumor site.
The form of radiation therapy chosen depends on the type and stage of the cancer being treated. External radiotherapy may be used to treat primary liver cancer in adults.
Clinical trials
New cancer treatments are being studied in clinical trials.
For some patients, participating in a clinical trial may be the best treatment option. Clinical trials are part of the cancer research process to determine if a new treatment is safe and effective or better than standard treatment.
Many of the standard therapies used in cancer treatment at this stage are based on previous clinical trials. Patients enrolled in clinical trials may receive the standard treatment or may be among the first patients to receive the new therapy.
Patient participation in clinical trials can help improve the way cancer is treated in the future. Clinical trials can often answer many medical questions and advance cancer research, even if they do not lead to effective new treatments.
Patients can enter a clinical trial before, during, or after cancer treatment. Some clinical trials are open only to patients who have not yet received treatment, and some are for patients whose disease has not improved. Still other clinical trials look at new treatments to stop cancer from coming back or to reduce the side effects of cancer treatment.
Possible follow-up tests
Patients may need repeat tests to diagnose their cancer or determine its stage, and there are also tests to help see how treatment is working. The decision to continue, change, or stop treatment is based on the results of the tests.
Some tests are continued after treatment ends, and the results can show whether the disease has improved or whether the cancer has come back. Such tests are also called follow-up tests or physical exams.