Treatment Options for Liver Cancer

Curative Treatments for Liver Cancer

Currently, there are two curative treatments for liver cancer:

  • Surgical resection
  • Liver transplantation

Surgical Resection

Surgical resection by partial hepatectomy is the treatment of choice for most patients with localized, resectable liver cancer where the cancer is confined to the liver and there is no evidence of metastases to the lymph nodes or other areas of the body. Unfortunately, since most patients with liver cancer already have advanced-stage disease at the time when they are diagnosed, surgical resection is only an option for about 30% of patients who are diagnosed with localized, resectable liver cancer.

During a partial hepatectomy, the surgeon removes either a segment of the liver that contains the tumor or an entire lobe of the liver. In a healthy liver, up to 80% of the organ can be surgically removed and the remaining healthy liver tissue will regenerate (produce more healthy liver tissue) and be capable of performing the vital liver functions necessary to sustain life. Patients with advanced liver cirrhosis are not considered good candidates for surgical resection because their diseased liver cannot regenerate healthy liver tissue following surgery.

Although surgical resection is considered as a curative treatment for liver cancer, the long-term prognosis following this treatment modality is dependent upon a number of factors including:

  • Size of the tumor - In general, the prognosis is better for smaller tumors (less than 5.0 cm) than for larger tumors.

  • Degree of liver cirrhosis - In general, the prognosis is better for patients who do not have liver cirrhosis than for those with extensive liver cirrhosis.

  • Extent of residual liver function - In general, patients with poor residual liver function have a worse prognosis than those with good residual liver function.

Improvements in surgical techniques for partial hepatectomy have reduced the incidence of life-threatening complications, with most major cancer centers reporting an operative mortality rate of less than 5%. In general, 5-year survival rates for patients with localized, resectable liver cancer have been reported to range from 30% to 70%.

Liver Transplantation

Liver transplantation is also considered to be a curative treatment for liver cancer. This involves surgically removing the patient's entire liver (total hepatectomy) and replacing it with a healthy liver from a cadaveric (non-living) donor. A major drawback of liver transplantation is finding a transplant donor and patients with liver cancer who are eligible candidates for liver transplantation often have to wait for a significant period of time before a donor liver can be found.

Unfortunately, liver transplantation is a treatment option for only a small proportion of patients with liver cancer. In general, liver transplantation is most likely to be successful in patients with liver cancer who meet the following criteria:

  • Have a liver tumor smaller than 5.0 cm
  • Have up to three liver tumors smaller than 3.0 cm
  • Have no significant portal hypertension (high blood pressure in the portal vein that carries blood to the liver)
  • Have no evidence of spread of the tumor to lymph nodes or other areas of the body

The likelihood for a successful outcome is increased if liver transplantation is performed within 6-months following diagnosis of liver cancer. Unfortunately, due to the shortage of cadaveric donors, many patients with liver cancer have to wait up to 12-months or longer before a donor liver can be found. It has been estimated that in the United States about 18,000 patients are waiting for a cadaveric liver donor transplant, whereas, the actual number of donors available is only about 5,000. Since 1998, the United Network for Organ Sharing (UNOS) has established a priority scoring system for allocating cadaveric livers to patients with liver cancer based on the severity of their liver disease. More information about UNOS can be found at http://www.unos.org/.

In order to prevent further progression of the tumor for those patients who are awaiting a liver transplant, a variety of palliative treatments may be used including radiofrequency ablation, percutaneous ethanol injection, and chemotherapy.

Living donor liver transplantation, as an alternative to cadaveric liver transplants, is currently being explored as a treatment option at some transplant centers around the world. In this procedure, a portion of a living donor's healthy liver is surgically removed and is transplanted into the recipient whose diseased liver has been removed by a complete hepatectomy. Currently, only about 3,000 living donor liver transplants have been performed worldwide and the long-term impact on survival has not yet been well established.