Treatment options for liver cancer

A team of health professionals will discuss the best treatment for you. This depends on factors such as your cancer type and stage and how well your liver is working. You might have one or more treatments. The most common treatments are surgery, heat treatment, drug treatments and radiotherapy.

This page is about treatment for primary liver cancer. Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The team usually includes:

• a specialist surgeon

• cancer specialists (oncologists) who treat cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)

• a liver specialist (hepatologist)

• an interventional radiologist who uses scans and images to carry out some cancer treatments

• a specialist cancer nurse (also called clinical nurse specialist or CNS)

• a pathologist who examines any cancer or tissue the surgeon removes

• a radiologist who looks at your scans and x-rays

• a palliative care doctor who specialises in controlling cancer symptoms

Your treatment depends on:

• where the cancer is in your liver

• the size of the cancer and whether it has spread (the stage)

• the type of cancer

• whether the cancer has spread to another part of the body (this spread is also called secondary cancer or metastases)

• how well your liver is working

• your general health and level of fitness

A member of your MDT will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments for primary liver cancer are:

• surgery
• embolisation (TAE or TACE)
• heat treatment to destroy cancer cells (thermal ablation) - radiofrequency ablation (RFA) or microwave ablation (MWA)
• radiotherapy
• targeted and immunotherapy cancer drugs, such as atezolizumab and bevacizumab

Surgery

You might have tests to see if surgery is an option for you. There are 2 types of surgery for primary liver cancer:

• an operation to remove part of the liver (liver resection)
• a liver transplant

Liver resection

A liver resection might be an option if your cancer is only in your liver and the rest of your liver is healthy. You are more likely to have this type of surgery if you don't have cirrhosis (scarring of the liver due to previous damage).  A surgeon can remove a small area, or up to three quarters of the liver. The liver is able to recover and regrow. Your surgeon will explain what is possible in your situation.

A rare type of liver cancer called fibrolamellar carcinoma develops more often in people who do not have cirrhosis. It is often possible to remove these cancers with surgery.

Liver transplant

People who have cirrhosis usually can't have a liver resection because the rest of the liver isn't healthy enough. In some situations, your surgeon may suggest a liver transplant if you have cirrhosis of the liver and you have: 

• a single tumour no more than 5cm across
• a single tumour that is 5 to 7cm across and has not grown for at least 6 months
• no more than 5 small tumours, each no larger than 3cm across 
• a level of alpha fetoprotein (AFP) less than 1000 

Finding a donor is difficult and can take months. You may need other treatments to control the growth of the cancer while you are waiting for the transplant .

Severe cirrhosis of the liver or your general health can mean you aren't fit enough for a transplant. Your team will discuss the best treatment options for your individual situation.

Embolisation treatment (TAE or TACE)

Embolisation is a treatment that blocks or reduces the blood supply to the cancer.

You might have trans arterial embolisation (TAE) to cut off the blood supply to the cancer. Your doctor does this by injecting a substance such as a gel or tiny beads to block the liver's blood supply.

Some people have chemotherapy directly to the area of your liver that contains the cancer before the blood supply is blocked. This is called chemoembolisation or trans arterial chemoembolisation (TACE). 

You usually have this treatment if you can't have surgery, or to help control the cancer while you are waiting for a liver transplant. Or you may have this treatment to shrink a tumour so that it then becomes small enough to remove with surgery.

Heat treatment (thermal ablation)

There are different types of thermal ablation for liver cancer. You might have:

• radiofrequency ablation (RFA)
• microwave ablation (MWA)

These treatments use heat to destroy cancer cells. You might have thermal ablation if your cancer is very small, or if you can't have surgery. Or you may have it to help control the cancer while you are waiting for a liver transplant.

Radiotherapy treatment

Radiotherapy uses radiation, such as x-rays, to kill cancer cells. There are different types of radiotherapy for liver cancer:

• stereotactic ablative radiotherapy (SABR)
• selective internal radiotherapy treatment (SIRT)

You might have radiotherapy treatment if you can't have surgery, or to help control the cancer while you are waiting for a liver transplant.

Targeted and immunotherapy cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. These are called immunotherapy.

You might have targeted or immunotherapy treatment if other treatments aren’t suitable for you. You may have one drug, or a combination of drugs.

Advanced liver cancer

Advanced liver cancer means that the cancer has spread beyond the liver to other parts of your body. Treatment aims to help you live longer and to maintain a good quality of life by controlling the growth of your cancer and treating symptoms. 

You might have: 

• targeted and immunotherapy cancer drugs 
• radiotherapy, usually to areas of the body where the cancer has spread 

Your doctor will also offer treatments to help control your symptoms. These symptoms can include pain, weight loss, shortness of breath, jaundice. Sometimes people with liver cancer and cirrhosis may get a build up of fluid in the abdomen (ascites).

Tell your doctor and nurses about any symptoms you have so they can treat them. They can also refer you to a symptom control team (palliative care team) to help manage your symptoms.

Your choices

Your doctor might offer you a choice of treatments. They will discuss the advantages and disadvantages of each with you. You can ask how these treatments might control any side effects. This helps you make the right decision for you.

You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might need to make further choices as your situation changes. It helps to find out as much as possible each time.

You can stop your treatment whenever you want to if you find them too much to cope with.

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial.

Doctors and researchers do trials to:

• improve treatment
• reduce the side effects of treatment
• develop new treatments

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful.