Liver Cancer

Treatment

The late stage at which liver cancer is often diagnosed, its resistance to standard chemotherapy, its tendency to recur after surgery in many patients, and the complications caused by pre-existing liver disease make it a particularly challenging cancer to treat. At Mayo Clinic, teams of specialists combine their expertise to develop comprehensive treatment programs for people with all stages and types of liver cancer. The most appropriate treatment options for you depend on the size, location and stage of the tumor, whether the tumor has spread to other organs or nearby blood vessels, how well your liver is functioning, and your age, overall health and personal wishes.

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Surgery

If you have been diagnosed with liver cancer, surgery often offers the best chance for a cure. Removing the diseased portion of your liver eliminates the cancer and prevents its spread to other parts of your body. The liver has a remarkable capacity for regeneration and can continue to function when as much as 80 percent of liver tissue is removed.

Whether surgery would be effective for you depends on a number of factors, including the number, size and location of the tumors and the overall health of your liver.

Surgical options for liver cancer at Mayo Clinic include:

• Liver resection: The best treatment for cancer that hasn't spread beyond the liver is surgical resection, which removes the part of the liver containing the tumor. Mayo Clinic surgeons successfully perform a large number of these demanding procedures every year, using techniques that spare healthy tissue and reduce blood loss.
• Laparoscopic liver resection: Surgeons at Mayo Clinic helped pioneer the use of minimally invasive (laparoscopic) surgery for liver tumors. Instead of a long abdominal incision, laparoscopic resection requires just three or four small "keyhole" incisions, similar to those routinely used in gallbladder operations. People treated laparoscopically have much less post-operative pain, a shorter hospital stay and a faster return to their normal activities than do patients who undergo traditional open surgery.
• Liver transplantation: In some cases, people with small, early-stage tumors confined to the liver or bile ducts who cannot undergo resection may be considered for a liver transplant. During transplantation, surgeons remove the diseased liver and replace it with a healthy, donated organ. Mayo Clinic has one of the world's largest and most successful liver transplant programs.
  
  Mayo surgeons have been at the forefront of innovative transplant procedures, including living donor transplants and the domino transplant, in which the functioning, explanted liver of a transplant recipient is donated to another patient.
  
  Mayo surgeons also pioneered the use of pre-operative chemotherapy and radiation combined with liver transplantation for people with advanced hilar cholangiocarcinoma, a type of bile duct cancer. Mayo Clinic is one of the few institutions in the world offering transplantation for people with bile duct tumors.

Mayo Clinic Transplant Centers also provide an array for services for transplant patients and their families before, during and after surgery, including an extensive support network, accommodations and comprehensive follow-up care.

Ablative therapies

By the time cancer is discovered, many people with primary liver cancer are no longer candidates for surgery. For some of them, especially those who have two or three small tumors, ablative therapies may be an option. In these minimally-invasive therapies, doctors apply electric current (radiofrequency ablation), laser light or alcohol directly to tumors to destroy cancerous tissue.

Mayo Clinic physicians perform most ablative therapies through the skin (percutaneously) using ultrasound or CT as a guide. The treatments are safe and effective, with a low rate of complications.

Mayo doctors are exploring another ablative treatment — photodynamic therapy — for people with inoperable bile duct cancer. Mayo Clinic was the first medical institution to use photodynamic therapy in humans and remains a leader in researching and using this procedure. Normally, doctors insert stents to open bile ducts blocked by tumors. Although stenting temporarily relieves difficult symptoms such as jaundice, it doesn't improve the disease.

Adding photodynamic therapy, which uses a photosensitizing drug and laser light to destroy cancer cells, not only can improve quality of life but also extend its length. The procedure, which requires expertise in both endoscopy and photodynamic therapy, is available at only a few specialized centers.

Embolization

Nearly 30 years ago, Mayo Clinic doctors pioneered the use of hepatic artery embolization, a procedure that cuts off blood flow to liver tumors by injecting small particles into the hepatic artery — the blood vessel that supplies tumors with nutrients and oxygen. Hepatic artery embolization is now usually combined with chemotherapy or radiation as an option for patients who have inoperable disease.

• Radioembolization: Mayo Clinic helped pioneer the use of radioembolization and is one of relatively few United States centers offering this procedure. Using the TheraSphere or SirSphere protocols, doctors inject tiny, radioactive beads into a branch of the hepatic artery. Normal blood flow carries the beads, which are no larger in diameter than a human hair, to the tumor. The beads release a high dose of radiation over a period of 10 days to two weeks.
  
  By targeting the tumor through the hepatic artery, healthy liver tissue is spared, allowing you to receive a higher radiation dose than you would receive from a beam outside your body. Radioembolization doesn't eliminate cancer, but it can improve the quality and length of life. It can also help shrink tumors in patients awaiting transplant surgery.
• Chemoembolization: In this treatment, doctors inject a potent chemotherapy cocktail and blocking material into the hepatic artery. Because the tumor is targeted directly, you may be able to receive larger doses of drugs than with systemic chemotherapy. Even so, the treatment is more painful and toxic to the body than radioembolization is. Chemoembolization doesn't cure cancer, but by shrinking tumors, it may relieve symptoms and prolong life.

Chemotherapy

At Mayo Clinic, an oral biologic agent is the standard of care for patients who aren't candidates for other therapies or who have recurrent cancer. Because one of the liver's main functions is to detoxify drugs, liver cancer has historically been resistant to chemotherapy. But now, a medication approved for other uses has been proven to slow the progression of advanced liver cancer and extend life in people with the disease.

Palliative Care

When cancer is so advanced that treatment options are limited, an experienced team of palliative care providers serves the social, psychological and spiritual needs of patients and their families. Your care team may include physicians from a number of fields — including specialists in bile duct obstructions — as well as dietitians, medical social workers, chaplains, psychologists, pharmacists and pain management specialists.

If you are facing a serious prognosis, your primary treatment team will consult with a Mayo Clinic palliative care expert who then works with your primary Mayo physicians.

Mayo Clinic also offers a wide range of complementary therapies to help relieve pain and the side effects of chemotherapy, including acupuncture, massage and vibration therapy, through the clinic's Complementary and Integrative Medicine program. The benefits of these treatments may extend beyond pain relief, helping you feel calmer and less anxious.