There are many forms of liver cancer, sometimes referred to as hepatic cancer. If the tumor cells originated as liver cells, it’s classified as a primary liver tumor. Those that develop as metastases – cancer cells carried from another part of the body – are more common. Metastatic liver tumors can spread from numerous sites, including the colon, lungs, breast, stomach and pancreas.
Liver tumors can be either benign, meaning they’re not cancerous and won’t spread to other parts of the body, or malignant, which means they can invade other organs. Most primary malignant liver cancers are classified as hepatocellular carcinoma or called hepatomas.
What are the symptoms?
What are the treatment options?
There are several treatment options, depending on the stage and specific type of tumor.
Resection, or surgical removal, is the common procedure for treating liver tumors that have not spread widely in the organ. Doctors make a large incision in the abdomen and a section of liver containing the tumor and some of the surrounding healthy tissue is removed.
Resection offers a five-year survival rate of 60 percent to 75 percent for primary liver tumors and 25 percent to 39 percent for metastatic liver tumors. About 70 percent to 80 percent of liver cancer patients are ineligible for surgery, however, because their cases are too advanced and/or their liver functions are extremely poor.
Surgery may pose significant risks of complications, such as infection, bleeding, respiratory and cardiac problems. About 2 percent to 6 percent of patients die as a result of liver cancer surgery. Surgery may be the only treatment necessary or it may be combined with chemotherapy or radiation for patients with widespread cancer or an advanced stage of their primary tumor.
Conventional radiation therapy, also known as external beam radiation therapy, typically uses wide fields of radiation to account for the tumor’s movement as the patient breathes. Since wide fields affect both the tumor and a significant amount of surrounding healthy tissue, treatment is typically broken into 30-40 sessions of small doses over several weeks.
This treatment can result in radiation-induced liver disease, a condition that may occur in the first few weeks after radiation therapy. In the most severe cases, it can lead to liver failure. Recent medical reports have shown patient survival rates after one year range from 47 percent to 95 percent and after five years from 11 percent to 25 percent. Outcomes are generally better when smaller tumors are treated with higher doses.
Chemotherapy is used when cancer cells are thought to be located throughout the body or present in a patient’s blood or other fluids, which occurs often with metastatic tumors and advanced-stage liver cancer.
Chemotherapy medication is delivered orally or through an IV and given to a patient either as the sole treatment or in combination with other types of liver cancer treatment. Chemotherapy affects both normal tissue and the cancer cells, so patients may experience side effects like severe nausea and vomiting, infections, fatigue and weight loss. Medical research has not shown that chemotherapy provides clinical benefits or prolonged survival for patients with advanced primary liver cancer.
Stereotactic radiosurgery’s ability to treat tumors with precisely focused radiation offers an important advantage for liver cancer patients. Accurate to within less than a millimeter, radiosurgery has minimal effect on surrounding health tissue.
This level of accuracy enables doctors to target liver tumors with high-dose radiation, which significantly reduces the number of treatments needed – usually between three and five over several days compared to 30-40 over several weeks required for radiotherapy systems.
Radiosurgery has other benefits as well, namely its ability to track tumors in real time. That means patients breathe normally during each treatment session, since the radiation beam adjusts automatically to the tumor location.
Liver cancer patients who can’t undergo surgery or radiation are sometimes treated with transcatheter chemoembolization, or TACE, which offers direct tumor treatment through a minimally invasive procedure. Doctors use real-time x-ray images to examine the tumor. A catheter in inserted through a small incision and guided through the artery that feeds the tumor. A combination of chemotherapy drugs and tiny solid particles, known as emboli, are injected into the tumor. The particles embolize, or block off, the blood supply to the tumor, starving it of oxygen.
TACE can be performed repeatedly, usually 10 – 12 months apart, and it can be combined with other treatments. It may not be appropriate, however, for patients with blockages of the veins that supply blood to the liver, very advanced cirrhosis or blockage of the bile ducts.
TheraSphere is a newer form of liver tumor embolization, or blocking the flow of blood to the tumor. Doctors inject millions of microscopic, radioactive glass spheres into the arteries that feed the tumor. The spheres lodge in the liver’s capillaries and expose the tumor to yttrium radiation.
Known as RFA, radio frequency ablation involves placing a needle-like probe inside the tumor. Radiofrequency waves pass through the probe to heat the tissue within the tumor and destroying it in the process. RFA is typically used with smaller liver tumors. RFA is often administered as an outpatient procedure, though it may require a brief hospital stay. The treatment also can be combined with chemotherapy to treat primary liver tumors.