There are many different treatment options available to patients who are not surgical candidates. Many of these treatments involve the latest advancements in liver tumor therapy and may not be well-known by your physician. Surgical oncologists that specialize in treating liver disease can offer the best insight of your condition and treatments best suited to meet your needs.

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.

If a tumor can be removed, surgery will be done. The figure below shows the extent of the typical surgeries used to remove liver tumors. Up to 75% of the liver can be removed since the liver does grow back if no cirrhosis or hepatitis is present (regeneration). The liver and peripheral nerves are the only tissues of the body capable of regeneration. In some patients, a combination of resection and radiofrequency ablation will be used. Following surgical removal of the tumor, some patients may have a hepatic artery infusion pump placed to treat the liver with chemotherapy in an attempt to prevent the return of the liver cancer.



After surgery, patients may be required to stay in the Intensive Care Unit (ICU) for one or two days, and remain in the hospital for 5 - 14 days. Patients who do not live in the Louisville area may need to stay locally for one or more weeks after discharge from the hospital. Patients usually need one to two months of recovery at home before they can return to their normal activities.

Chemotherapy may be given before or after surgery and is given intravenously. The schedule depends on the particular drug given. Patients receiving chemotherapy and radiation therapy do not need to be admitted to the hospital for these treatments.

Before surgery: Many patients with liver cancer have lost weight by the time they receive the diagnosis. However, to keep your body strong, it is important to maintain your weight before, during, and after therapy.

Good nutrition helps minimize the side effects of treatment. Side effects from chemotherapy and surgery may affect your ability to eat and may also cause your body to need more calories than usual. Eating small, frequent meals (four or five a day) of a balanced diet will help you maintain your weight and your strength. If needed, you may talk to a dietician who will help you with any nutritional questions or problems.

After surgery: A dietitian is available to help you plan ways to meet your nutritional needs.

When you are discharged from the hospital:

• You will be given a set of instructions regarding "do’s and don’ts" after major surgery.
• A prescription for pain and any other necessary medications will be given to you. Since constipation is a known side effect of the commonly prescribed pain medications, an over-the-counter laxative medicine is recommended (Senokot, Colace, etc.).
• You will need to return to the clinic or see your doctor every three to four months for routine checkups.

After surgery, you may have fatigue, diarrhea, weight loss, and a full feeling that does not disappear after meals. However, after a few weeks, these feelings will go away, and you will be able to return to a normal diet and routine.

If a tumor has spread beyond the liver or cannot be removed surgically, the next best treatment will be chemotherapy. Many different chemotherapy drugs and combinations of drugs are available for treatment. The appropriate drug therapy depends on your specific type of cancer, the extent of your disease, and your physical condition. Your doctor (medical oncologist) will explain the chemotherapy options, the expected outcomes and the associated toxicities.

Some patients may be asked to take part in studies, called clinical trials that test new treatments. These treatments may include new chemotherapy drugs or new combinations of different drugs. Radiation therapy treatments are sometimes a part of these clinical trials.
As more effective drugs become available, the treatment options for liver cancer may change. Your doctor will discuss the risks and benefits of various treatment options with you and your family. Ask your doctor any questions you have about the cancer or its treatment so that you will understand and feel comfortable with your treatment decision.

Many people are aware of the statistics regarding life expectancy, or prognosis, for liver cancer. Although statistics can be helpful, they can also be misleading. If you have questions about your prognosis, ask your doctor. Your doctor is the only person who knows enough about your case to discuss this with you.

Having cancer can change your life and the lives of your family members in many ways. Patients and their families often feel shock, anger, sadness, fear, frustration, and confusion when faced with a diagnosis of cancer. These feelings often come and go, and the experience is sometimes compared to an emotional roller coaster.

You may have many questions about the cancer, its treatment, and its effect on your life. Your doctors and nurses are the best people to answer these questions. You may also have questions about how your job, finances, and family relationships will be affected. Your social worker can suggest services and agencies that help provide financial aid, transportation, home care, and emotional support.

Living with any serious disease can be difficult and challenging. Many patients find it helpful to share their thoughts and feelings with a professional counselor or with other patients who are going through a similar experience. Others may find it easier to talk with a minister, priest, rabbi, or other religious leader. Your social worker can help you find support groups, counseling services, or other related resources.