On the one hand, the treatment of liver cancer depends on the stage of the tumor, i.e. its size and location. On the other hand, however, the patient’s age and state of health also play a decisive role in the choice of treatment method. The condition of the liver, i.e., whether or not cirrhosis is present, is equally important for the therapy.
Treatment methods for liver cancer: overview
In principle, a wealth of different therapeutic options is available for the treatment of liver cancer. Individual procedures can also be combined with each other.
- Surgery: partial removal of the liver or liver transplantation.
- Local therapy procedures: These range from sclerotherapy of the tumor to heat treatment or contrast media therapy to internal radiation of the liver.
- Drug therapy: chemotherapy or treatment with the active substance sorafenib.
- Palliative therapy: in this form of therapy is no longer the cure of the disease, but the improvement of the quality of life in the foreground.
Treatment of liver cancer: surgery
Surgery is currently the treatment option most likely to completely cure liver cancer. Whether liver cancer is treatable by surgery depends largely on the number of tumors, their location as well as their size. Another decisive factor is whether the liver tissue is still healthy or whether there is already advanced liver cirrhosis. In addition, the patient’s state of health must permit surgery. Smaller tumors in particular can usually be removed well by surgery. In addition to the tumor, surrounding healthy tissue is also removed to reduce the likelihood of cancer cells remaining in the body. The important thing with partial liver removal is that enough healthy liver tissue is left in the body to allow the liver to continue to function. For patients with cirrhosis, a liver transplant is a better decision than partial liver removal. This is because if part of the diseased liver is removed, the remaining liver tissue may not be sufficient to detoxify the body and liver failure may result. However, for a liver transplant to be performed, the patient must be in good general health. Certain concomitant diseases may also be an exclusion criterion for the procedure. In contrast to a partial removal, the patient must take medication for a long period of time after a liver transplant. These prevent the donor organ from being rejected.
Treatment of liver cancer: local therapy methods
The goal of local therapy procedures is to slow the progression of the disease, extend the survival span, and relieve concomitant symptoms. They are used when surgery for liver cancer is not possible. In addition, local procedures are also used to bridge the waiting period until transplantation. In sclerotherapy of the tumor, highly concentrated alcohol is injected through the skin directly into the liver tumor. In small tumors, this procedure can destroy the tumor and thus cure the disease. Radiofrequency ablation (heat treatment), on the other hand, uses a laser or radiofrequency oscillations to cook the tumor cells, which are then removed. Several sessions may be needed to completely remove the tumor. In transarterial chemo-embolization, a cytotoxin and a vaso-occlusive agent are injected into the branches of the hepatic artery that supply the tumor. The lack of supply causes the tumor to shrink. This is why this procedure is often used before surgery. With this method, the liver continues to be supplied via a second access – the portal vein. If this is blocked, the procedure cannot be used. In contrast medium therapy, a contrast medium (lipiodol) that accumulates in the liver is loaded with radioactive particles and injected into the hepatic artery. The agent accumulates in the tumor and kills the cells. Relatively new is the procedure of internal radiation, called selective internal radiotherapy (SIRT), which is based on contrast agent therapy. In this procedure, small beads to which a radioactive substance is bound are introduced directly into the vessels supplying the liver.Since the radiation only has a range of up to one centimeter, healthy tissue is not or only slightly affected by the radiation. The small beads additionally ensure that the vessels supplying the tumor are blocked.
Treatment of liver cancer: drug therapy.
Chemotherapy is used relatively rarely for liver cancer in Germany. Generally, it is performed when metastases have already formed or when no other therapy can be considered. In contrast to the local procedures presented so far, chemotherapy has an effect throughout the entire body. The drugs used in chemotherapy – known as cytostatics – primarily attack cancer cells. However, other rapidly dividing cells are also attacked, for example the hair root and mucous membrane cells. In addition to chemotherapy, sorafenib, an active ingredient that interferes with the tumor’s metabolism and thus specifically fights it, has been available for several years. The active ingredient is taken in tablet form and is used when liver cancer cannot be operated on. Most often, sorafenib is used to prolong the average survival time in an already advanced cancer.
Treatment of liver cancer: palliative therapy.
If liver cancer disease is no longer curable because of its advanced stage, palliative therapy is used to try to keep the patient’s quality of life as high as possible. It is mainly used for patients with terminal liver cancer. Palliative therapy focuses particularly on relieving pain and eliminating other discomfort caused by the tumor.
Liver cancer: follow-up care is important
After surviving liver cancer, follow-up care is essential. During follow-up examinations, doctors provide support for patients with physical or psychological problems. They also check whether concomitant diseases have arisen as a result of the therapy. If this is the case, the illnesses must be treated accordingly. However, the most important goal of follow-up care is to detect the possible recurrence of liver cancer at an early stage and to initiate appropriate treatment. As a rule, such a follow-up examination should be performed every six months.