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  • Q&A with Australian Health Practitioners

    What is the treatment for liver cancer?

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    Cancer Liver Cancer
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    Mr Dean Spilias

    Upper GI Surgeon (Abdominal)

    Dean graduated from the University of Melbourne in 1997 and went on to surgical training at the Royal Melbourne Hospital. During his residency he had … View Profile

    Treatment of liver cancer depends on the type of cancer, the stage or severity of the cancer, and the health of the individual (and in particular how healthy the liver is). 

    The types of cancer that can affect the liver include 

    1. Cancers that arise in the liver - primary liver cancers - in particular hepatocellular carcinoma (HCC), the commonest primary liver cancer (and the commonest liver cancer internationally). Cholangiocarcinoma, lymphoma, sarcoma are some of the other, less common types of cancer that can arise in the liver. 
    2. Cancers that arise elsewhere, but spread (metastasize) to the liver - called metastases (“mets”) or secondary cancers.

    The stage of a cancer depends on the size of cancer and how far it has spread. Once a cancer has spread beyond the liver, the treatment options decrease. 

    Hepatocellular carcinoma treatment can include:
    • surgical resection (removal) of the tumour; 
    • liver transplant for a small proportion of people; 
    • trans-arterial chemo-embolisation or TACE, where a chemotherapy agent is injected directly into the arteries supplying the liver and the cancer;
    • ablation or destruction of the tumour with a needle inserted into the liver;
    • or a type of chemotherapy (sorafenib) that can decrease the growth of the cancer in some people. 
    Surgical resection and liver transplant are the only treatments that are considered curative, although for smaller cancers there can be good results combining TACE with ablation. All of the treatments (apart from transplant) do some damage to the liver, and this can limit the treatment options as much as the stage of the cancer. 

    Hepatocellular carcinoma often occurs along with viral hepatitis (hepatitis B or hepatitis C) or cirrhosis of the liver; treatment or monitoring of these conditions is often required as part of the follow-up of liver cancer. 

    Liver metastasis, where a cancer has spread from elsewhere in the body to the liver, is often a sign of incurable cancer. However, this is not always the case, and some people can be treated very effectively by surgical resection. Different cancer types respond differently to surgery, and treatment needs to be determined on a case-by-case basis. 

    Where liver metastases cannot be removed surgically, options may include chemotherapy, or occasionally a type of radiotherapy (SIRT or SIRS) where tiny radioactive beads (“microspheres”) are injected into the liver and collect in the cancer deposits. 

    Because of the many options that need to be considered, a multidisciplinary team approach is usually used with liver cancer. Specialists from various fields - usually including surgeons, oncologists, radiologists and hepatologists - discuss each person on a case-by-case basis to realistically assess the chances of cure and the risks of each treatment option. 

    Treatment of liver cancer is a field of medicine that is evolving and clinical trials comparing different treatments may be available; these are usually considered at multidisciplinary team meetings. 

    Some additional online resources that may be useful include Cancer Australia's liver cancer page http://canceraustralia.gov.au/affected-cancer/cancer-types/liver-cancer
    and the Victorian Cancer Council's information page on liver cancer http://www.cancervic.org.au/about-cancer/cancer_types/liver_cancer 


    Dean Spilias
    http://www.uppergi.net

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