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A variety of palliative treatments are available for patients with localized, unresectable liver cancer that cannot be removed surgically due to either the location of the tumor within the liver, poor liver function, or other underlying health problems. The term "localized" refers to the confinement of the cancer to the area of the liver without evidence of spread to the lymph nodes or other areas of the body. As mentioned previously, palliative treatments for liver cancer are not curative but rather are intended to control the disease and prevent further progression, thereby, prolonging survival.

Palliative treatments for liver cancer include:

• Radiofrequency thermal ablation
• Percutaneous ethanol injection
• Cryosurgery
• Hepatic arterial embolization
• Systemic chemotherapy
• Hormonal therapy
• Radiation therapy

Radiofrequency Thermal Ablation

Radiofrequency thermal ablation is a technique that is used to destroy the tumor with high-energy radiofrequency waves. During this procedure, the surgeon inserts a special probe called a radiofrequency electrode directly into the tumor with the assistance of imaging guidance such as ultrasound, CT, or MRI. Various surgical techniques can be used to insert the electrode into the tumor including percutaneously (through the skin), laparoscopically, or by performing a laparotomy (creating an open incision into the abdomen). Once the probe has been placed into the tumor, radiofrequency energy is applied that heats up the electrode and causes destruction of the tumor. In general, radiofrequency thermal ablation is used for the treatment of localized, unresectable nodular-type liver tumors that are 3.0 to 5.0 cm in size. Complications of this technique, which may develop in less than 10% of patients, include fever, pain, irregular heart beats, bleeding, and formation of liver abscess.

Percutaneous Ethanol Injection

Another commonly used technique used for treating patients with localized, unresectable liver cancer is called percutaneous ethanol injection (PEI). In this technique, the surgeon uses ultrasound guidance to insert a small needle into the tumor and then injects absolute ethanol directly into the tumor to destroy the cancer cells. Multiple treatments (usually 4 to 8 sessions) are required to shrink the liver tumor and the procedure is repeated once or twice weekly. This procedure is performed on an outpatient basis under local anesthesia. In general, PEI is useful for the treatment of smaller (3.0 cm or less) nodular liver cancer tumors and is usually recommended for patients with three or fewer tumors. The most common side-effects of PEI are fever and pain which usually resolve within a few days after the procedure. The estimated 5-year survival rate for PEI has been reported to range from 30% to 60%.

Cryosurgery

Another technique that is sometimes used to destroy liver tumors is known as cryosurgery. This procedure involves placing a probe containing liquid nitrogen into the tumor and destroying the cancer cells by exposing them to freezing temperatures. Potential complications of cryosurgery include hypothermia (low body temperature), bleeding, irregular heart beats, kidney failure, and bile duct injury.

Hepatic Arterial Embolization

This is one of the most widely used palliative treatments for patients with localized, unresectable liver cancer. The basic goal of hepatic arterial embolization is to deprive the tumor of its blood supply by embolization (occlusion) of the hepatic artery which supplies blood to the tumor. Once the blood supply to the tumor has been cut-off, the cancer cells die and the tumor shrinks.