Although some cancers are treated mainly on the basis of tumor size, liver cancer is usually more complex, requiring more individualized therapy. This is particularly important when cancer occurs in people who already have diseased or damaged livers, as is often the case. Whatever form of treatment doctors prescribe for liver cancer, it is important for patients to remember that all treatments have limitations, as well as potential benefits. Because every therapy involves side effects, any decision about treatment will depend on a careful evaluation of the patient’s liver function, blood vessels, degree of disease and overall health. The reality is many patients find themselves ineligible for surgery or transplantation. For these patients, physicians often find the best treatment results from using multiple techniques or drugs, trying one, seeing what helps, and moving along to the next therapy as needed. Lahey oncologists will work closely with other specialists on the cancer care team to determine the best treatment approach for each patient.
When developing a treatment plan, physicians consider:
- How well the liver is functioning
- The size, number, and location of the liver tumors
- The presence of coexisting medical conditions that may affect the patient’s ability to tolerate therapy
The best treatment for primary liver cancer is also the only truly curative one-cutting and removing the malignant tissues and possibly surrounding lymph nodes. The formal medical term for this is liver resection, but unfortunately, it is not often possible for a number of reasons. First, if a patient’s liver is cirrhotic or poorly functioning, it might not be safe to perform the operation. Second, the tumors may be so small or widespread that surgery will not be effective in preventing the cancer from returning.
Transplantation involves replacing the diseased organ with healthy liver tissue from a donor. It is interesting to note that
- Liver transplants can be performed using organs from deceased or live donors
- In the case of live donors, only part of the healthy liver is transplanted to the patient; this type of transplant is possible because liver tissue regenerates so rapidly
- Since 1999, the Lahey Liver Transplant Team has carried out nearly 400 transplants-58 in 2006, more than any other liver transplant center in the New England region (UNOS Region 1)
- The Lahey live adult donor liver transplant (LDLT) program is the 3rd largest in the country, with nearly 140 surgeries performed to date
Chemotherapy is the term for specialized anticancer drugs given by mouth or intravenously. Chemotherapy medications work against tumors anywhere in the body, not just in the liver. Although highly effective for many types of tumors, chemotherapy does not always work well against primary liver cancer. This is because the liver’s primary job is to filter out all toxic chemicals from the body-including the chemotherapy.
Radiation, which applies high-dose energy such as X-rays directly on small areas of the body, is used to destroy many forms of cancer cells. In liver cancer, radiation is particularly challenging because it may be more damaging to healthy liver tissue than to cancerous cells. For this reason, standard radiation is seldom used in treating patients with liver cancer unless it involves one of the newer techniques such as radiofrequency ablation and stereotactic radiation, described below.
The following treatments target only the liver tumor, not the entire organ:
- Chemoembolization, also called hepatic artery chemoembolization, is a promising new procedure that involves injecting high doses of chemotherapy directly into the blood vessels that feed the malignancy. Also injected are special oils and proteins that form a dam, which closes off blood vessels and isolates the tumor. Chemoembolization attacks liver cancer two ways: it destroys the existing tumor, and then chokes off its blood supply, preventing further growth. Please refer to our chemoembolization brochure [link to PDF] to learn more.
- Cryoablation is another form of liver-directed therapy that uses liquid nitrogen to isolate and kill the cancer. Specialists inject super-cold nitrogen right inside the tumor, freezing and ultimately destroying the cancer cells. An alternative form of this treatment is ethanol ablation, where liquid alcohol is injected directly into the tumor.
- Radiofrequency ablation [RFA] uses heat energy in the form of radio waves to kill the liver tumor. Using ultrasound or CT scan equipment as a guide, the physician inserts a metal probe into the tumor. Radio waves emitted at the tip of the probe deliver thermal energy right to the center of the tumor. This heat energy destroys the surrounding tissue, killing the tumor.
- Advanced stereotactic radiation uses specialized equipment called the Trilogy System, physicians are able to target the tumor site with high-dose beams of precisely focused external radiation, achieving a much greater degree of accuracy than with traditional radiation techniques. Lahey was one of the first hospitals in New England to offer this advanced technology.
Researchers are constantly exploring new approaches to improve treatment of liver cancer. On the horizon for patients with liver cancer are several emerging therapies:
- Biological therapy, or biological response modifier therapy, is used to “switch on” certain bodily substances that can restore or mobilize the patient’s own natural defenses against cancer.
- Lahey physicians have joined researchers in Israel in studying MRI-guided, focused ultrasound, a bloodless technique that destroys tumors affecting the liver and other organs. The entire procedure, which uses an FDA-approved device already in use at Lahey to treat uterine fibroids, is performed without cutting or puncturing the skin. Physicians use MRI as a visual guide to help them target the tumor and aim a highly focused ultrasound beam at the liver tumor under, or between, the ribs.
Benign and malignant tumors or neoplastic disease have traditionally been approached systemically with chemotherapy or radiotherapy, or locally with surgery. Recent advancements in minimally invasive therapies now permit the use of techniques to heat tumors to the point of cell death. This form of killing tumors is called thermal ablation. We currently perform thermal ablation using radio frequency and with magnetic resonance-guided high-intensity focused ultrasound.
Radiofrequency ablation (RFA) has emerged as a safe, easy and predictable technology for thermal ablation in bone, lung, liver, kidney, prostate, lymph nodes and other soft tissues. It has also been used to treat uterine fibroids, breast tumors and bony metastases. RFA is also being used to treat pain due to soft tissue neoplasms. This technique relies on needles that are used as electrodes and placed with imaging guidance provided by CT, ultrasound or MRI.