Liver cancer can be primary or metastatic. Primary liver cancers are those that originate in the liver. They are significantly more likely to affect patients with liver scarring (cirrhosis). Cirrhosis usually appears in patients with alcoholism or chronic hepatitis B or C infections. Metastatic liver cancers are those that originate in another organ—such as the colon, bowel, pancreas, or skin—and spread to the liver.
Primary Liver Cancer
The first line of treatment for the most common type of primary liver cancer, hepatocellular carcinoma or HCC, is a transplant or surgical resection (removal) of the tumor. However, transplants and surgical resection are only feasible when the cancer is caught early; if there is any chance that the cancer has spread beyond the liver, transplantation is not an effective therapy. Because liver cancers cause few symptoms until later stages, they are often not diagnosed until the opportunity for a transplant has passed. Typically, to be eligible for a transplant, a patient must have a single tumor less than 5 cm or fewer than four tumors, with no single tumor greater than three centimeters in diameter, and must have had no cancer outside the liver.
The second line of treatment for primary liver cancer is surgical removal (resection) of the cancerous part of the organ. However, if the cancer is not caught early, there may not be enough non-cancerous tissue left to maintain liver function after a resection. Only one in four liver cancers is caught early enough for surgery to be effective.
When transplant or resection is not possible, chemoembolization and radio-frequency ablation are the treatments of choice. These therapies can be applied singly or together.
2010 Multi-specialty Expert Concensus on Hepatocellular Carcinoma (HCC)
“Although surgical resection and liver transplantation are the only treatment modalities that enable prolonged survival in patients with hepatocellular carcinoma (HCC), the majority of HCC patients presents with advanced disease and do not undergo resective or ablative therapy. Transarterial chemoembolization (TACE) is indicated in intermediate/advanced stage unresectable HCC even in the setting of portal vein involvement (excluding main portal vein). Sorafenib has been shown to improve survival of patients with advanced HCC in two controlled randomized trials. Yttrium 90 is a safe microembolization treatment that can be used as an alternative to TACE in patients with advanced liver only disease or in case of portal vein thrombosis. External beam radiation can be helpful to provide local control in selected unresectable HCC. These different treatment modalities may be combined in the treatment strategy of HCC and also used as a bridge to resection or liver transplantation. Patients should undergo formal multidisciplinary evaluation prior to initiating any such treatment in order to individualize the best available options.”*
Secondary (Metastatic) Liver Cancer
Patients with liver tumors that have spread from other organs are not transplant candidates because the risk of post-transplant tumors developing elsewhere in the body is too high. Instead, these patients are treated by removal of the original tumor (where the metastasis originated) and systemic (whole-body) chemotherapy. If the liver tumors fail to respond to this approach, or if they cause pain or other symptoms, they are targeted by local therapies. Surgical resection is preferred, but may not be possible on the basis of tumor size, location, or involvement of other structures. In these cases, chemoembolization and radio-frequency ablation are the first-line treatments.
* HPB 2010, 12, 313–320
More information about liver cancer from the Socieity of Interventional Radiology at: http://www.sirweb.org/patients/liver-cancer/
