Medical advice

What is the treatment?

This depends on the type of cancer that you have and how much of the liver is affected by the cancer.

Primary liver cancer

If you develop a small hepatoma and the function of the remaining liver is good enough, it may be possible to remove the cancer by an operation. If the liver cirrhosis is more advanced, the stress of an operation even to remove a small cancer may be too much. Liver transplantation to remove your liver containing the cancer and replacing it with a healthy donor liver is an option, but is a major operation. Patients need to be carefully assessed, and be fit enough in other regards to be considered for liver transplantation.

Other available treatments for hepatomas are the injection of medicines, or internal placement of an instrument releasing damaging sound waves (called ‘radio frequency ablation’ or ‘RFA’), directly into the cancers to kill the cancer cells. The blood vessels to the area of the liver containing the cancer can also be injected with chemotherapy drugs to try to kill the cancer cells, or with substances that block the blood vessels and starve the cancer of its blood supply.

Cholangiocarcinomas often cause narrowing or blockage of the main bile ducts, causing jaundice. The blockage can be relieved by placing a plastic or metal tube (known as a ‘stent’) through the narrowing. This is usually done with an endoscope – a flexible tube passed through the mouth. Occasionally surgery can be performed to remove the cancer depending on where in the liver the cancer is and the general heath of the patient. Newer treatments are being developed using medicine to make cancer cells extremely sensitive to light, which is then directed onto the cancers during an endoscopy test.

Secondary liver cancer

Treatment of secondary (metastatic) liver cancer often depends on where the cancer started. In some patients with spread to the liver from bowel cancer, both the bowel cancer and the secondary liver cancer can be removed by an operation in an attempt to cure the cancer. This depends on the size and number of cancers present, and in which part of the liver the cancer spread is located.

Most other types of secondary cancers in the liver cannot be removed or cured by surgery. These are usually treated with drugs (chemotherapy) to slow down the growth of cancer cells. This may also relieve discomfort by shrinking larger cancers which are pressing on the capsule surrounding the liver. Many types of chemotherapy treatments are available, often given as an out-patient procedure, and your doctor may refer you to see a doctor who specialises in chemotherapy (an oncologist).

As well as seeing doctors in the hospital, your GP will be informed of your condition and will be happy to review you to ensure your symptoms are well controlled. Specialist nurses who work in hospitals and the community trained in the care of patients who have cancer (Macmillan nurses), are there to discuss any aspect of your condition with you.

How will I know I am getting the right treatment?

Each patient found to have liver cancer is discussed at a special meeting where a team of experts which include physicians, surgeons, radiologists (doctors who specialise in cancer scans), pathologists (doctors trained to examine specimens of cancer tissue) and oncologists (cancer treatment doctors) consider the best options for treatment. Sometimes, you may be offered the opportunity to enter a clinical trial when newer, potentially better treatments, are being compared to established treatments. Without these important trials, we will not know how to improve the outcome for patients in the future.

Will my doctor tell me about how long I might have to live?

As already discussed, different treatments are used to reduce the size of liver cancer. However, cancers within the liver can be difficult to cure. Patients often ask how this condition will affect their chances of survival, and this can be a very difficult question to answer for any particular individual. Some people prefer to know all the facts about their condition and how it is going to affect their life. Others choose not to ask particular questions. Once the type of liver cancer that you have is known, it is worth appreciating that your doctor will be pleased to discuss any aspect of your illness that you choose. If you have any questions about your own treatment, don’t be afraid to ask your doctor or the nurse who is looking after you. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. Two pairs of ears can be better than one and you may value the support.

What research is needed in liver cancer?

As the number of people affected by primary liver cancer is rapidly increasing, and a large proportion of all patients with cancer will have secondary spread to the liver, it is crucial that further research is performed. In order to understand how to prevent these cancers, we need more understanding of why and how they develop. There is real demand for new effective treatments for liver cancers to be developed to improve the quality and
duration of life for those diagnosed with liver cancer.

Useful websites:

Our infomation section has information on other digestive diseases and cancers

www.cancerbackup.org.uk

CancerBackup is a support network for sufferers of cancer as well as their families and friends.

www.cancerhelp.org.uk

CancerHelp UK is a free information service about cancer and cancer care for people with cancer and their families. It is hosted by Cancer ResearchUK

www.macmillan.org.uk  

This has information to help you and your family understand what could happen at each stage of your experience of cancer, and to help you access further information and support.