DEAR MAYO CLINIC: Is removing part of the liver always the best treatment for liver cancer? What if the cancer has spread?
ANSWER: Surgery to remove part of the liver sometimes can be a successful treatment for liver cancer, but that’s not always the case. A variety of other options also are available to treat liver cancer. How much the cancer has spread, along with a person’s age and overall health, helps determine the best treatment choice.
Your liver is an organ about the size of a football that’s located in the upper right portion of the abdomen, beneath the diaphragm and above the stomach. Several types of cancer can form in the liver. The most common is hepatocellular carcinoma, which begins in liver cells called hepatocytes. Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.
When a cancerous tumor in the liver is small, and the liver still works well, surgery may be recommended to remove the tumor and a small part of the healthy liver tissue around it. If the cancer is still in its early stages, the surgery may be all that’s necessary to treat liver cancer.
If the liver is not working well and, as a result, cannot handle surgery, or if a tumor is in a location within the liver that makes it hard to remove, then other treatments may be used instead. In a procedure called radiofrequency ablation, a thin needle is inserted into the tumor and then heated. The heat destroys the cancer cells. Another option is cryoablation, in which extreme cold is used to kill cancer cells.
In some cases, chemotherapy drugs or a radioactive substance can be injected directly into a liver tumor, causing the cancer cells to die. Chemotherapy or radiation also may be infused throughout the liver if the cancer has started to spread within the liver, but has not moved into other organs.
In some select cases, a liver transplant can be an effective treatment for liver cancer. This option typically is used only for people with early-stage cancer who also have an underlying liver disease that is significantly affecting their liver function.
When cancer has spread outside the liver, or in cases where other treatments have not been successful, targeted drug therapy may help. A drug called sorafenib, which has been available for more than a decade, and a newer drug called regorafenib, which was approved in 2017, can be used to treat liver cancer. They are not chemotherapy drugs. Instead, they work by shutting off some of the genes that cause the cancer to grow, and they restrict blood flow to the tumors. That helps control liver cancer and slow its growth.
The U.S. Food and Drug Administration recently approved a form of immunotherapy with a drug called nivolumab for liver cancer. Immunotherapy works by stimulating the body’s immune system to fight cancer. Studies have shown that this type of immunotherapy works for about 25 percent of people with the hepatocellular carcinoma form of liver cancer.
There also are quite a few new drugs being researched for liver cancer. Many focus on gene mutations or molecular changes that can affect the disease. Some are being studied in combination with immunotherapy to see if that approach could offer additional benefit to more patients. This breadth of research holds promise for advancing the treatment of liver cancer and offering new options for patients in the future. — Dr. Steve Alberts, Medical Oncology, Mayo Clinic, Rochester, Minnesota