Liver Cancer Recurrence: What to Ask

This page is for people whose liver cancer may have come back. It covers treatment options, transplant, key tests, and questions to ask your liver team.

Liver cancer usually comes back inside the liver. NCI calls this the most common pattern of failure after treatment meant to cure the cancer.

There are two ways that happens. The first tumor may have spread within the liver. Or the damaged liver may have grown a brand new one.

NCI says that in clinical practice the two cannot be told apart. So do not expect a clean answer to this question.

For a recurrence that stays inside the liver and has not invaded blood vessels, NCI lists four options: liver transplant, surgery, ablation (destroying the tumor with heat or other methods) and radiation.

Ask which of the four your team is weighing, and why the others are out.

NCI describes a trial of 166 people whose liver cancer came back after surgery or ablation. All had one tumor of 5 cm or less and well-preserved liver function. Focused radiation was compared with heat ablation. At two years, the treated spot was still controlled in 92.7 percent of the radiation group and 75.8 percent of the ablation group.

The Milan criteria are the rules used to decide who can get a liver transplant. NCI states them plainly: one tumor smaller than 5 cm, or two to three tumors each smaller than 3 cm.

NCI adds that transplant is considered when surgery is ruled out by multiple small tumors or by impaired liver function.

Ask whether you meet those criteria now, and whether a transplant center should see you.

The blood test for alpha-fetoprotein (AFP) is often watched, but NCI says it is not sensitive or specific enough to diagnose liver cancer on its own.

It can rise in bile duct cancer and in cancer that has spread from the bowel. A liver mass with a raised AFP is not automatically liver cancer.

NCI lists liver function, measured with the Child-Pugh score, alongside tumor size and spread as the things that pick the treatment.

Ask what your score is and whether it has changed.

• Is this the old tumor or a new one, and does it matter here?
• Is it still only in my liver?
• Am I a candidate for transplant, surgery, ablation or radiation?
• Do I meet the Milan criteria today?
• What is my Child-Pugh score now compared with before?
• Can imaging confirm this, or do I need a biopsy?
• Which trial is open to me?

A recurrence usually sits in a liver that is already scarred, so watch the liver as well as the tumor.

MedlinePlus puts a long list under "get emergency medical help right away" for cirrhosis. It is worth reading as written, because several of these are easy to mistake for something that can wait until Monday.

• Call 911 or go to the nearest emergency department if you vomit blood, pass black tarry stools, bleed from the back passage, or see blood in your urine. Do not drive yourself.
• Call 911 or go to the nearest emergency department if you become suddenly confused, are hard to wake, or your alertness changes or gets worse. Do not drive yourself.
• Call 911 or go to the nearest emergency department if your abdomen swells, or existing swelling suddenly gets worse. MedlinePlus lists new or suddenly worse ascites as an emergency, not a same-day call. Do not drive yourself.
• Call 911 or go to the nearest emergency department if your eyes or skin turn yellow for the first time, or the yellow deepens quickly. Do not drive yourself.
• Call 911 or go to the nearest emergency department if you have abdominal or chest pain, shortness of breath, diarrhea, vomiting more than once a day, or a fever above 101°F (38.3°C). That is the fever level MedlinePlus uses on its cirrhosis page. Do not drive yourself.
• If you are having chemotherapy or other treatment that lowers white blood cells, call your care team right away, day or night, for a temperature of 100.4°F (38°C) or higher, chills, sore throat, mouth sores, burning when you urinate, or redness at a catheter or port site. Do this even if your temperature is normal. Do not wait for 101°F.
• Contact your care team right away if you notice any new symptom, such as new pain under the right ribs or weight loss without trying. MedlinePlus says to contact your provider if you develop symptoms of cirrhosis. Do not wait for the next scan date.

If your oncology team has given you a lower fever number than 101°F, use theirs.

Cancer Staging and Biomarker Testing explain the terms that come up most when liver cancer comes back. Clinical Trial vs Standard Treatment, Palliative Care, and Questions to Ask Your Doctor cover the decisions that follow a liver cancer recurrence.

These questions were drawn from current patient guidance for liver cancer (hepatocellular carcinoma):

• NCI PDQ - Adult Primary Liver Cancer Treatment (Patient Version)
• NCI PDQ - Adult Primary Liver Cancer Treatment (Health Professional Version)
• MedlinePlus - Cirrhosis