Question:
How is cancer of the liver treated?

Answer:
In many instances, individual cases are discussed at a multi-disciplinary conference. Doctors from all the relevant specialties (surgery, medical oncology, radiation oncology, gastroenterology, diagnostic radiology, and pathology) review the main information on the case and make a recommendation on the appropriate multi-disciplinary management. You can request that your case be presented at this conference.

The treatment recommended for you will depend on the extent of your disease, the specific type of liver cancer (primary or metastatic), and your general health. Your test results will help your doctor plan a treatment program that is best suited for you. There are four forms of treatment for liver cancer. One or a combination of these treatments may be used.

Surgery: If the tumor has not spread outside of the liver and if it is localized, then surgery may be recommended. Surgery may include:

• removing the area of the liver containing the tumor
• killing the tumor using a special needle that destroys the tumor with heat (called radiofrequency ablation)
• placing a device called an infusion pump to give chemotherapy directly to the liver, or any combination of the above.

Interventional Radiological Procedures: These procedures use x-ray imaging to guide the delivery of agents used to kill cancer cells. During embolization a catheter is inserted into a blood vessel supplying the tumor. The cancer cells are then killed by injection of blocking agents to obstruct the blood supply to the tumor. A catheter may also be used for arterial infusion to deliver chemotherapeutic drugs into blood vessels that directly supply the tumor. With ablation, a needle (for the delivery of drugs) or other therapeutic devices is placed through the skin, into the tumor, to kill the cancer cells.

Chemotherapy: This therapy uses drugs to kill cancer cells. The drugs usually are given intravenously (through a vein into the bloodstream). Some patients receive chemotherapy via a hepatic artery infusion pump. During surgery a pump is placed under the skin of the abdomen and filled intermittently with chemotherapy agent(s). The tip of the pump catheter is placed in the hepatic artery to directly infuse treatment into the liver.

Radiation Therapy: This treatment uses radiation waves to kill cancer cells. Radiation usually is administered by a machine directed at the body area to be treated. Following planning with computer simulation, treatments usually are given on an outpatient basis, Monday through Friday for 2 to 5 weeks. Radiation therapy is not used as commonly in the treatment of liver cancer as are surgery and chemotherapy.
Sometimes radiation is given together with chemotherapy or given during surgery.