Liver cancer | Types of treatment - surgery, liver ablation

About treatment for liver cancer

Your liver cancer treatment will be planned by a team of specialists called a multidisciplinary team (MDT).

This page is about treatment for primary liver cancer (cancer that started in the liver). We have other information about treatment for secondary liver cancer (cancer that has spread to the liver).

The treatment you have for liver cancer will usually depend on:

where the cancer is in the liver
the size of the tumour or tumours
how many tumours there are
whether the cancer has spread outside the liver
whether any important blood vessels in the liver are affected
how well your liver is working
your general health.

Doctors are looking at newer treatments and different ways of giving existing treatments. Your specialist may talk to you about taking part in a research trial.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our liver cancer forum to talk with people who have been affected by liver cancer, share your experience, and ask an expert your questions.

Controlling symptoms

This is sometimes called palliative treatment or supportive care. You might need help to control symptoms, such as:

pain
ascites - a build-up of fluid in the tummy area (abdomen).
jaundice - yellowing of the eyes and skin, feeling itchy, pale poo (stools) or very dark pee (urine).

We have more information about controlling the symptoms of cancer in the liver and about coping with advanced cancer.

Possible treatments for liver cancer

Treatments may include:

Surgery

Surgery may cure HCC. Surgery may involve a liver transplant or an operation to remove part of the liver. But often surgery is not possible. This might be because the cancer is too advanced or the liver is too damaged to cope with surgery.
Tumour ablation

Tumour ablation is where a doctor applies heat to the cancer cells to destroy them. This may be used instead of surgery. It works well with small tumours.
Chemoembolisation

In chemoembolisation, a chemotherapy drug is put into the liver and the blood supply to the tumour is cut off. Doctors may recommend this treatment when the cancer is advanced in the liver but has not spread outside it. It may help to control the cancer.
Radioembolisation

Radioembolisation works in a similar way to chemoembolisation. It uses radiation instead of chemotherapy to destroy cancer cells. It is also called selective internal radiotherapy (SIRT).
Radiotherapy

Some people have a type of high-dose radiotherapy that closely targets tumours in the liver. This is called stereotactic radiotherapy. It is used to try and control areas of cancer in the liver. Radiotherapy can also be used to ease symptoms such as pain. You may have this treatment if the cancer has spread to a part of the body, such as the bones. This is called palliative radiotherapy.
Targeted therapy

Doctors may use a targeted therapy drug such as sorafenib or lenvatenib if the cancer is advanced in the liver or has spread outside it. A drug called regorafenib can be used if you have had sorafenib and need more treatment. Other targeted therapy drugs may be used in clinical trials.
Chemotherapy

Chemotherapy may be used to treat advanced liver cancer. It may control the cancer, help you live for longer and reduce symptoms.

If you decide not to have treatment, there is a still a lot that can be done to control symptoms and support you. Your doctor can refer you to a team of doctors and nurses who specialise in controlling symptoms. This is called a palliative care team.

About our information

References

Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: doi.org/10.1007/s00268-016-3700-1 [accessed Feb 2020]

NICE. Lenvatinib for untreated advanced hepatocellular carcinoma: Technology appraisal guidance (TA 551) [Internet]. 2018. Available from: www.nice.org.uk/guidance/TA551 [accessed Feb 2020]

NICE. Liver disease. Quality standard (QS 152) [Internet]. 2017. Available from: www.nice.org.uk/guidance/QS152 [accessed Feb 2020]

NICE. Liver cancers overview [Internet]. 2019. Available from: pathways.nice.org.uk/pathways/liver-cancers/liver-cancers-overview [accessed Feb 2020]

NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: www.nice.org.uk/guidance/ta555 [accessed Feb 2020]

Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from doi.org/10.1093/annonc/mdy510 [accessed Feb 2020]

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.