The primary treatment options for liver cancer include surgery, tumour ablation, embolisation, radiation therapy and targeted therapies. The type of treatment you receive will depend on a number of different considerations, such as the type of liver cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how liver cancer treatment works in the private health system.
Surgery for liver cancerSurgery
Surgery is used to remove the cancerous tissue from the liver. This means that the liver may need to be partially removed (known as a partial hepatectomy) or replaced through a liver transplant. The treatment you receive will depend on the size and stage of your cancer, your age and general health.
During a partial hepatectomy, also known as a liver resection, the surgical oncologist removes the portion of liver with cancerous tissue. There are three types of partial hepatectomies: a right or left hepatectomy (removing the right or left part of the liver), extended right or left hepatectomy (removing most of the liver) or a segmentectomy (removing a very small section of the liver). This procedure is only suitable people with good liver function who have a single tumour which has not grown into the blood vessels. Following surgery, the remaining liver will begin to function on behalf of the entire liver and, in many cases, grows back to normal size.
The two approaches for partial hepatectomy, performed under general anaesthesia, include:
- Open hepatectomy – Where a long incision is made through the skin and abdominal wall to access your liver
- Keyhole (laparoscopic) hepatectomy – A minimally invasive procedure that uses three to four small incisions to access the liver. Laparoscopic procedures result in less postoperative pain and complications, shorter hospital stay and faster recovery compared to open hepatectomy
A liver transplant is a treatment option for people with tumours that are unable to be removed through a partial hepatectomy (based on the size and stage of the cancer). It involves the removal of the entire liver, which is then replaced with a donated liver. Typically, a liver transplant can be used for people with small tumours that have not grown into the blood vessels.
Tumour ablation for liver cancerTumour ablation
If a primary tumour is 3cm or smaller, ablation can destroy it without removing the tumour itself. Tumour ablation is often provided when surgery is not an option or when waiting for a transplant.
Common types of tumour ablation
There are three main types of tumour ablation.
Radiofrequency ablation and microwave ablation
Radiofrequency ablation and microwave ablation uses the heat from high-energy ratio waves and electromagnetic waves respectively to kill cancerous cells. This is delivered through interesting needle-like probe into the tumour.
Using a needle-thin probe and low temperature gases, cryoablation destroys a tumour by freezing it.
Ethanol (alcohol) ablation
Alcohol ablation uses pure alcohol to target and kill the tumour.
Chemotherapy for liver cancerChemotherapy
Traditional chemotherapy is not routinely used for primary liver cancer. Instead, transarterial chemoembolisation (TACE) is used to deliver chemotherapy drugs directly to the cancerous tumour while blocking the blood flow through the hepatic artery (embolisation) for a short time. This allows the chemotherapy drug to stay in the cancerous tumour longer.
The TACE procedure that involves the injection of the chemotherapy drugs through a plastic tube inserted from a small cut near the groin. It is usually performed by an interventional radiologist.
Traditional chemotherapy can be provided for secondary liver cancer, which is cancer in the liver that has spread from other areas of the body.
Targeted therapies for liver cancerTargeted therapies
Targeted therapies are specialised drugs that destroy specific proteins in liver cancer cells. They work by blocking proteins in the cells’ control centre to prevent liver cancer cells from multiplying and spreading. Certain types of targeted therapy drugs known as tyrosine kinase inhibitors are commonly used to treat advanced liver cancers such as advanced hepatocellular carcinoma (HCC).
Types of tyrosine kinase inhibitor drugs include:
These drugs work by blocking a protein called tyrosine kinase which allows cancer cells to grow, and by preventing the supply of small blood vessels that provide nutrients to the cancer cells. They also block other kinase protein receptors that are responsible for the growth and spread of cancer cells. They are taken orally as a tablet or capsule once or twice a day.
Immunotherapy for liver cancerImmunotherapy
Immunotherapy trains the immune system to recognise and fight liver cancer cells, which may hide behind proteins known as “checkpoints”.
Common immunotherapy medicines
Common types of immunotherapy treatments for liver cancer include:
Atezolizumab is an immune checkpoint inhibitor drug that works by binding onto proteins on the surface of cancer cells, helping our own immune system to kill the cancer cells. It is commonly given in combination with a targeted therapy called bevacizumab. Atezolizumab is used to treat advanced liver cancer that is unable to be surgically removed or that has spread to other areas of the body.
Bevacizumab is a targeted therapy drug that works by preventing the supply of small blood vessels that provide nutrients to the cancer cells.
How often you receive immunotherapy treatment will vary depending on you and your cancer, however atezolizumab and bevacizumab are commonly combined and given by intravenous infusion every three weeks.
Radiation therapy for liver cancerRadiation therapy
Radiation therapy uses highly targeted radiation to destroy cancer cells and can be delivered internally or externally. It can be an effective option for people who cannot have surgery and/or cancer that has spread to areas outside of the liver.
Types of radiation therapy commonly used for people with liver cancer include:
Stereotactic radiation therapy
Stereotactic radiation therapy to the liver is most commonly used to treat primary liver tumours. However, it can also be used to treat secondary cancers in the liver where suitable. This is typically available at our sites that are affiliated or attached to a hospital campus, due to additional support these patients require during treatment.
Stereotactic radiation therapy for liver cancer involves the use of specialised equipment to ensure the accurate delivery of treatment. Your oncologist will organise for some markers to be implanted into your liver prior to treatment. This allows us to monitor the exact position of the tumour during treatment, ensuring the tumours are precisely identified and targeted, allowing the surrounding healthy liver to have minimal exposure to radiation during treatment.
Using our auto beam hold technology, if the machine detects that the markers move outside of the treatment beam, the beam will automatically switch off. The treatment will only proceed when the tumour is within the treatment beam.
Selective internal radiation therapy (SIRT)
Selective internal radiation therapy (SIRT) may also be used as a treatment option for liver cancer. Also known as radioembolisation, SIRT targets liver cancer internally through small radioactive beads. These beads travel through the hepatic artery (the artery that provides oxygen to the liver) and slowly emit small bursts of radiation to shrink nearby tumours. SIRT is a common technique for secondary liver cancer.
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When you are diagnosed with liver cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer. This may take into account the Barcelona Clinic Liver Cancer (BCLC) system and the TNM staging system.
Potentially operable or transplantable liver cancer (Stage I and some Stage II)
If your tumour is small enough and hasn’t invaded surrounding blood vessels, you may be able to have surgery (partial hepatectomy). Your overall health and liver function are key factors in determining your eligibility for surgery. Liver transplants can also be considered, especially if your liver is not healthy. However, liver transplants have extensive waiting times. While waiting, you may be treated with ablation or embolisation.
Inoperable liver cancer that has not spread
Liver cancer is considered inoperable when tumours are too large to be removed safely or if it’s grown in a high-risk area of your liver. Interoperability can also be determined if there are multiple tumours or if your overall health isn’t where it needs to be for you to have surgery safely. Treatment in this stage of cancer primarily focuses on palliative care. Treatment options include ablation, embolisation, targeted therapies (including immunotherapy), chemotherapy, radiation therapy or a combination of these treatments.
Advanced liver cancer
In this stage, the liver cancer has spread to surrounding lymph nodes or possibly to other organs and is no longer treatable with surgery. Treatment for advanced liver cancer primarily focuses on palliative care. You may be treated with immunotherapy drugs in combination with targeted therapy, while radiation therapy can help with your pain management.
- American Cancer Society. (2019). Chemotherapy for Liver Cancer. Retrieved on 18 October 2021 at https://www.cancer.org/cancer/liver-cancer/treating/chemotherapy.html
- American Cancer Society. (2019). Embolisation Therapy for Liver Cancer. Retrieved on 18 October 2021 at https://www.cancer.org/cancer/liver-cancer/treating/embolization-therapy.html
- American Cancer Society. (2019). Surgery for Liver Cancer. Retrieved on 18 October 2021 at https://www.cancer.org/cancer/liver-cancer/treating/surgery.html
- American Cancer Society. (2019). Radiation Therapy for Liver Cancer. Retrieved on 18 October 2021at https://www.cancer.org/cancer/liver-cancer/treating/radiation-therapy.html
- American Cancer Society. (2010). Targeted Drug Therapy for Liver Cancer. Retrieved on 18 October 2021 at https://www.cancer.org/cancer/liver-cancer/treating/targeted-therapy.html
- American Cancer Society. (2021). Treatment of Liver Cancer, by Stage. Retrieved on 18 October 2021 at https://www.cancer.org/cancer/liver-cancer/treating/by-stage.html
- Cancer Council. (2019). Understanding Liver Cancer: A guide for people affected by primary liver cancer or secondary cancer in the liver (2018). Retrieved on 3 October 2019 from https://www.cancer.org.au/content/about_cancer/ebooks/cancertypes/Understanding_cancer_liver_booklet_May_2018.pdf#_ga=2.102268481.1791040564.1569977015-345937469.1569977015
- Cancer Council. (2021). Liver transplant. Retrieved on 18 October 2021 at https://www.cancercouncil.com.au/liver-cancer/treatment/liver-transplant/
- Cancer Council. (2021). Types Of Cancer: Liver cancer. Retrieved on 18 October 2021 at https://www.cancer.org.au/cancer-information/types-of-cancer/liver-cancer
- eviQ. (2020). Hepatic advanced or metastatic atezolizumab and bevacizumab. Retrieved on 18 October 2021 at https://www.eviq.org.au/medical-oncology/upper-gastrointestinal/hepatic/3881-hcc-advanced-or-metastatic-atezolizumab-and-b
- Gauthier, A., & Ho, M. (2013). Role of sorafenib in the treatment of advanced hepatocellular carcinoma: An update. Hepatology research : the official journal of the Japan Society of Hepatology, 43(2), 147–154. https://doi.org/10.1111/j.1872-034X.2012.01113.x
- Finn, Richard S et al. “Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma.” The New England journal of medicine vol. 382,20 (2020): 1894-1905. doi:10.1056/NEJMoa1915745
- John S Lubel, Stuart K Roberts, Simone I Strasser, Alexander J Thompson, Jennifer Philip, Mark Goodwin, Stephen Clarke, Darrell HG Crawford, Miriam T Levy and Nick Shackel. (2020). Australian recommendations for the management of hepatocellular carcinoma: a consensus statement, Med J Aust 2021; 214 (10): 475-483. || doi: 10.5694/mja2.50885
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