Liver Cancer Treatment Options

This page gives patients and families an overview of the main treatments for liver cancer. Treatment depends on two things at once:

• How far the cancer has spread.
• How well the rest of the liver works.

That second point matters more here than in most other cancers. Most liver cancer grows in a liver already damaged by cirrhosis (heavy scarring of the liver). Some treatments are simple in a healthy liver but not safe in a scarred one. Removing part of the liver is one. It depends on how much healthy liver is left. So two people with a similar-sized tumor can end up with very different treatment plans.

A partial hepatectomy is surgery that removes the tumor and some healthy tissue around it — a wedge, a lobe, or a larger piece of the liver. Doctors mostly use it when the rest of the liver works well enough to cope with losing a part.

A liver transplant replaces the whole diseased liver with a healthy donor liver. It is an option when:

• The cancer is only in the liver.
• The tumors meet set limits on size and number.
• A donor liver is available.

It works well for early-stage disease. It can also help people whose cirrhosis is too severe for partial removal. A transplant treats the cancer and the liver disease at once. After a transplant for early-stage liver cancer, NCI's PDQ summary says about 70% of people who meet the criteria are alive five years later.

Ablation destroys a tumor directly, without an open operation. Doctors use it for small tumors, or for people who can't have surgery.

Types of ablation include:

• Radiofrequency ablation and microwave ablation, which use heat delivered through a needle placed right into the tumor.
• Percutaneous ethanol injection, which puts concentrated alcohol into the tumor through the skin.
• Cryoablation, which freezes and destroys the tumor tissue.

Doctors choose among them based on the tumor and the liver.

Embolization blocks or reduces blood flow to the tumor. Doctors deliver it through a catheter (a thin tube) into the hepatic artery, the vessel that feeds most liver tumors.

Transarterial embolization, or TAE, blocks blood flow alone. Transarterial chemoembolization, or TACE, also delivers a dose of chemotherapy right to the tumor at the same time. This concentrates the drug where it's needed and limits exposure elsewhere in the body. Doctors often use them for tumors that can't be removed or ablated. They're also used to control the cancer while someone waits for a transplant.

When liver cancer has spread too far for local treatments, drugs become the main approach. Targeted therapies block specific growth signals cancer cells rely on. These include sorafenib, lenvatinib, cabozantinib, regorafenib, and others. Immunotherapy, which helps the immune system attack cancer, has become an increasingly important option too. Examples include:

• Atezolizumab, often paired with bevacizumab.
• Nivolumab.
• Nivolumab combined with ipilimumab.

Immunotherapy has become an increasingly important option for advanced liver cancer.

Because so much liver cancer grows in a damaged liver, doctors weigh more than the cancer's stage. They also weigh how much healthy liver reserve remains. Liver cancer staging systems reflect this. They look at both the tumor and liver function.

This is worth knowing going in. A treatment plan may look less aggressive than you'd expect for the tumor's size. That can reflect real limits on what the rest of the liver can safely handle. It doesn't mean the team is taking the cancer less seriously.

• National Cancer Institute — Liver Cancer Treatment.
• National Cancer Institute — Adult Primary Liver Cancer Treatment (PDQ).