Treatment of Liver Cancer

Early diagnosis and aggressive intervention are key to improving the prognosis of those diagnosed with liver cancer. Promising advances in the treatment of liver cancer are also giving patients new hope. Treatment of liver cancer is particularly challenging when compared with other types of cancer because in addition to the cancer itself, many patients have livers that have sustained damaged by chronic hepatitis B resulting in cirrhosis and various degrees of liver failure.

For each individual patient, the potential benefits of the various treatment options must be balanced with the risk of liver failure and how it affects the patient's quality of life.

Surgical Treatment

When the tumor is small or deemed surgically resectable, and the patient's liver condition is deemed fit for the planned resection, surgical removal offers the best chance for long-term survival. Despite complete removal of the tumor, patients are still at risk for recurrent disease, and they need to be followed closely long-term, especially during the first year when the risk of recurrence is greatest.

Nonsurgical Treatment

For patients who are not suitable resection candidates for anatomic or medical reasons, a number of treatment options, though limited in effectiveness, are available or being investigated in an attempt to control the disease long-term and with the aim of maintaining normal quality of life.

§  Traditional chemotherapy is generally ineffective, causes many side effects that may severely impair the patient's quality of life, and often does not prolong survival.

§  Intrahepatic arterial chemoembolization or chemoinfusion (TACE or TAC) has been adopted in the treatment of selected patients with unresectable lesions by the Stanford Multi-disciplinary Liver Tumor Clinic for the last four years. This treatment is not suitable for patients who already have signs of moderate liver failure and in patients with blockage of the portal vein. Long-term treatments with TACE or TAC have been associated with prolonged patient survival, and those who have good control or shrinkage of the tumor may even become suitable candidates for surgical resection or transplantation.

Liver Transplantation

Liver transplant is a treatment option for HCC that are surgically or medically unresectable, provided that the tumor is small (less than 5 cm or fewer than 4 lesions), confined to the liver, and without invasion into the blood vessels. More extensive tumors have a high risk for early recurrence and death after liver transplantation. After transplantation, the patient must receive either hepatitis B immunoglobulin (HBIG) or lamivudine, or both, to prevent HBV reinfection of the new liver.

Early diagnosis of small tumors is the only effective way of improving the outcome of liver cancer treatment, and that is only possible through screening of the high-risk population.