Your treatment will depend on the exact type of liver cancer you have.
Your clinical team
A multidisciplinary team (MDT) will look at your results and discuss your treatment options. The team includes doctors, nurses and other specialists depending on your case. Your team could include a hepatologist (liver specialist), surgeon, oncologist (cancer specialist), dietitian, physiotherapist and others.
Your team will also include a clinical nurse specialist (CNS) who will be your main point of contact. You can call them with any questions or worries you have, to follow up on test results, or to discuss your case.
You might need supportive treatment to help with symptoms. This is sometimes called palliative care and it isn’t only for people at the end of their life. You can be assigned a nurse who specialises in palliative care and symptom control.
Surgery for liver cancer
You may have surgery for bile duct cancer, hepatocellular cancer (HCC) or gallbladder cancer.
Types of surgery for liver cancer
There are several different operations you may have for liver cancer. You may have a:
- Tissue sample (biopsy) taken
- Liver resection
- Liver transplant
Which of these is suitable for you will depend on the type of liver cancer you have and how far it’s grown.
Preparing for liver surgery
Before your operation, it will help to make sure you are as well as possible, especially stopping smoking.
You may have some tests before your operation. These are to make sure you are well enough for the anaesthetic and will recover well. You may have these done at a pre-assessment clinic. If your hospital runs an enhanced recovery programme, you may also have advice on diet and exercise.
It’s best to plan well in advance for any help you’ll need after surgery. You’ll need someone to take you home and stay with you for a while afterwards if you live alone.
On the day of the operation, you will need to stop eating and drinking for a few hours before the anaesthetic. Check with your doctor about which medicines you should take that morning and let them know if you live with diabetes.
After your surgery
When you come round, you’ll be in the recovery room. Once the anaesthetist is happy for you to be moved, your recovery nurse will take you to a high dependency ward or to intensive care (ITU) if you’ve had a transplant.
Let your nurse know if you are in pain or feel sick. They’ll be able to give you medicines to help.
You should have been taught breathing and leg exercises. Do these regularly to help lower the risk of complications, such as infection or blood clots.
How long you’ll be in hospital will depend on the operation you’ve had. Your nurse will give you an out patient appointment before you leave. You’ll also have and a phone number to call if you have any problems. If you are worried about anything, do ring them. If there’s a problem, they’d rather know sooner than later.
Ablation means to destroy tissue. You can have it done more than once. You may have it to:
- try and cure an early liver cancer
- control the cancer while you’re waiting for a liver transplant
- shrink a tumour so it can be removed, or is easier to control
Cryoablation destroys the tumour by freezing it. Thermal ablation destroys it with heat, using radio waves (RFA) or microwave ablation (MWA).
You have this done in hospital and usually stay overnight afterwards. First, you’ll have a sedative or general anaesthetic. Then, the doctor puts the needle through your skin and into the liver tumour to give the treatment.
After ablation, you may have a fever, feel sick, tired and have aches and pains for a few days. This is caused by the cancer dying and breaking down. Contact your doctor if your temperature goes above 38C.
Embolization, TACE and TARE
Embolization means cutting off a tumours blood supply. Then it doesn’t get any food or oxygen from your blood.
TACE stands for Trans Arterial Chemo Embolization. You have chemo directly to your liver tumour before the tumour’s blood supply is blocked, which seals the chemo in.
TARE stands for Trans Arterial Radio Embolization. You have radioactive beads put next to the liver tumour before having the blood supply blocked.
You may have TACE and TARE to:
- try and cure early hepatocellular cancer (HCC)
- control HCC while you’re waiting for a transplant
- treat advanced liver cancer
You have these treatments in hospital. You have to rest in bed afterwards, so may need to stay overnight. After embolization, you may have a fever, feel sick, tired and have aches and pains for a few days. This is a sign that the cancer is breaking down. Contact your doctor if your temperature goes above 38C
Radiotherapy is treatment with high energy X-rays, which kills cancer cells. With external radiotherapy, the beams are aimed at the cancer from outside the body, similarly to having an X-ray.
To cure a small liver tumour, you may have stereotactic external radiotherapy. This is a highly targeted treatment. The beams are very precisely aimed at the cancer from several directions. So they can destroy the cancer without damaging healthy liver tissue. You may have a single treatment or a course of treatments – it varies, depending on your situation.
To control symptoms of an advanced cancer (such as bone pain), you usually have a short course of radiotherapy, or even a single treatment.
Radiotherapy does have side effects. You may have red, sore skin or hair loss in the treatment area, sickness, diarrhoea or tiredness. Side effects usually go a few weeks after treatment finishes.
Targeted cancer medicines
Targeted cancer medicines are also sometimes called biological therapies. They target changes caused by altered genes (mutations) in cancer cells.
There are number of different types. Which you have depends on the type of liver cancer you have and on the results of tests on your cancer cells.
- Cancer growth blockers block chemical signals that cancer cells need to grow and multiply.
- Anti-angiogenics (say: an-gee-oh-gen-icks) stop cancers growing blood vessels.
- Monoclonal antibodies (MABs) find cancer cells by looking for proteins that they make.
A MAB used for hepatocellular liver cancer (HCC) blocks a protein that stops your immune system attacking the cancer cells. So it’s also a type of immunotherapy.
Chemo drugs kill cancer cells while doing little harm to normal cells. It’s a systemic therapy, which means it circulates throughout your body in your bloodstream.
You may have chemo before or after surgery. Or you may have it for advanced cancer that has spread from where it started.
Chemo does have side effects. These usually go once your course of treatment is over. The side effects vary, depending on which drugs you’re having. Common side effects include feeling sick and tiredness.
For HCC, you may have chemo as part of a treatment called TACE (see Embolization). Unlike regular chemo, this is a local treatment as it’s delivered directly to the liver tumour. So it has fewer side effects.
Treatment for symptoms and advanced cancer
There is treatment available for advanced liver cancers, either to control them or help with symptoms. Doctors use many of the same treatments they use for earlier stage liver cancer.
You may have a stent (tube) put in to help bile to drain and relieve jaundice. Or have fluid drained from your tummy (abdomen) if it’s building up and making you uncomfortable.
Your doctor can help with medicines to relieve cancer symptoms such as sickness or pain. A dietician may help if you are having trouble with your appetite. You may also see specialist symptom control nurses, who can visit you at home. They can help you manage your symptoms and give you and your family support and advice.
Many people try complementary therapies to help them relax and feel better.