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Treatment

How Is Liver Cancer Treated?

At present, liver cancer is potentially curable only in its early stages. Treatment options for liver cancer include:

Surgery

Surgery is currently the most effective treatment for liver cancer, but it depends on the health of the patient. Two types of surgery are used to treat liver cancer. The first, called a partial hepatectomy, removes only the part of the liver infected by the cancer. The second, called a total hepatectomy, removes the entire liver. If the entire liver is removed, it will be replaced with liver tissue from a donor in a procedure called a liver transplant.

Partial Hepatectomy

For a partial hepatectomy, the surgeon removes part of the liver and a margin of surrounding healthy tissue. The number, size, and location of the tumor(s) determines how much of the liver is removed. The surgeon can remove up to 75% of the liver in a healthy patient without causing him or her any long-term deficit. The remaining tissue performs all normal liver functions while the liver slowly regenerates itself. It may be several weeks before the liver fully regrows.

This type of surgery has several potential risks and side effects. Bleeding is a serious risk both during and after surgery. If too much tissue is removed during surgery, the liver may not be able to function properly, which can potentially lead to liver failure. Recurrence (the cancer returning) is also possible because the same damage that may have caused the original cancer is still present.

A partial hepatectomy is a major surgery. Patients who have a partial hepatectomy often feel weak and tired after surgery.

Total Hepatectomy/Liver Transplant

For a total hepatectomy, the entire liver is removed and replaced with liver tissue from a donor. This procedure is called a liver transplant. A liver transplant is an option for patients whose cancers are small but cannot be completely removed. This may be due to the location of the tumor(s) or poor liver function.

It may take a long time to find an appropriate match for a liver donation, and patients may remain on a waiting list for lengthy periods of time. In the interim, patients waiting for a liver will undergo other treatments to control the cancer.

In addition to the potential risks and side effects of a partial hepatectomy, patients receiving a liver transplant also face the risk that the body will reject the new liver tissue. Patients are given drugs to suppress the body’s immune system to prevent this from happening and must take these drugs for the rest of their lives. These drugs have potential risks and side effects of their own. Because the drugs are suppressing the body’s immune system, the patient is also at risk for serious infections.

Minimally Invasive Surgical Procedures at BMC

In some cases, BMC offers laparoscopic and robotic surgeries to patients who are able to have their cancer resected. These minimally invasive procedures reduce the length of surgical incisions (cuts) and can lead to quicker recovery.

Laparoscopic Surgery

The surgeon makes a series of small incisions in the abdomen. The laparoscope (a long camera) is inserted into one of the incisions. Surgical instruments used to remove the tumor(s) are inserted into the others. The surgeon uses imaging techniques, such as CT, MRI, or ultrasound, and the real-time images produced by the laparoscope to guide the instruments in the removal of the tumor(s). When the part(s) of the liver containing the tumor(s) has been removed, the incisions are closed.

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BMC also offers liver transplantation, through a partnership with Lahey Clinic.

Interventional Therapy

Interventional therapy uses localized treatments, such as ablation and embolization, to destroy the cancer without surgically removing it.

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There are several types of ablation, including:

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Serious complications resulting from ablations are rare. Potential risks and side effects include abdominal pain, bleeding in the chest or abdomen, fever, and liver infection.

Embolization

Embolization cuts off the tumor’s blood supply by clogging or cutting off the hepatic artery. The tumor cannot grow without its blood supply, and parts of it may die.

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Potential risks and side effects for embolization include abdominal pain, fever, nausea, infection in the liver, blood clots in the liver, and swelling in the gallbladder.

Medical Therapy

Medical therapy uses drugs to destroy cancer cells.

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Potential risks and side effects for radiation therapy include skin problems where the radiation is directed, tiredness, nausea, and vomiting. Radiation therapy, if given in combination with chemotherapy, may worsen the side effects of chemo. Most side effects generally disappear once treatment is completed.

References

American Cancer Society. 2015. Liver Cancer Overview. PDF. http://www.cancer.org/acs/groups/cid/documents/webcontent/003058-pdf.pdf

National Cancer Institute. 2009. What You Need To Know About™ Liver Cancer. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/liver.pdf