Treatment of liver cancer requires a multidisciplinary approach, carefully tailored to the individual patient’s tumour characteristics, liver function, and overall health.
Since liver cancer often develops alongside long-term liver disease or cirrhosis, doctors must carefully balance removing the tumour with keeping the liver working well. The main goal is to get the best result while helping the patient stay comfortable and active. Knowing the full range of treatment of liver cancer helps doctors, patients, and families make better decisions.
When liver cancer is found early, some treatments may offer a cure. These include surgery, liver transplant, and treatments that destroy the tumour directly. In later stages, doctors may use drug treatments, targeted therapies, immune-based drugs, and comfort-focused care. The treatment of liver cancer follows staging systems like the Barcelona Clinic Liver Cancer (BCLC) system. This system helps pick the right plan based on the patient’s condition.
Surgical and Transplant Options for Early Liver Cancer
Surgery to remove the tumour, called surgical resection, is one of the main ways to try to cure liver cancer. Doctors remove the tumour along with a part of healthy liver. This is usually an option only when the patient has one tumour and a liver that still works well. Also, there should be no signs of high pressure in the portal vein. The chance of success depends on the tumour’s size and place, how well the liver works (often measured by the Child-Pugh score), and if the cancer has spread. If chosen carefully, surgery can lead to long-term survival or even a cure.
Liver transplant is another possible cure, especially for patients who meet the Milan criteria. This means they have one tumour smaller than or equal to 5 cm, or up to three tumours all under 3 cm. The cancer must not have spread or invaded blood vessels. A transplant not only removes the cancer but also fixes the liver disease underneath, often cirrhosis. In well-matched patients, survival after five years is over 70%. But finding a donor organ and the risk of tumour growth while waiting remain big challenges.
Local Treatments and Tumour Control
Therapies like radiofrequency ablation (RFA) and microwave ablation (MWA) destroy the tumour using heat. Doctors often do these through the skin using imaging to guide them. These are best for small tumours, usually under 3 cm, and in people who can’t have surgery. Some hospitals also use cryoablation or high-intensity focused ultrasound (HIFU). These treatments can control the tumour well and are sometimes used while patients wait for a transplant.
If the cancer can’t be cured, doctors use locoregional treatments to slow it down and reduce symptoms. One common method is transarterial chemoembolisation (TACE). In this procedure, doctors put chemotherapy directly into the artery that feeds the tumour. Then, they block that artery with small particles. This keeps the drug inside the tumour and cuts off its blood supply. TACE is usually used in medium-stage liver cancer and has helped patients live longer.
Another locoregional option is transarterial radioembolisation (TARE), also known as selective internal radiation therapy (SIRT). This method sends small radioactive beads into the liver artery. These beads release radiation straight into the tumour with less harm to nearby tissue. Doctors may choose TARE when TACE isn’t safe, like if the portal vein is blocked.
Systemic Therapies in Advanced Liver Cancer
When liver cancer is at a late stage, drug treatments become the main choice. For years, the only approved drug was sorafenib, which helped patients with advanced liver cancer live longer. However, treatment of liver cancer has changed quickly with the arrival of new drugs and immune therapies.
Medicines like lenvatinib, regorafenib, cabozantinib, and ramucirumab target tumour growth in different ways. Some of these are used first, while others are given after other treatments fail. Immune therapy has shown good results, especially with immune checkpoint inhibitors like nivolumab and pembrolizumab. These help the body’s own defence system find and kill cancer cells.
A strong combination of atezolizumab (which blocks PD-L1) and bevacizumab (which blocks blood vessel growth) has worked better than sorafenib. This mix is now a standard for some patients with advanced liver cancer. Researchers continue testing new drug mixes and treatment steps to get better results with fewer side effects.
These therapies can slow cancer and help patients live longer. Still, they can cause problems like tiredness, high blood pressure, diarrhoea, skin issues, and immune reactions. Doctors need to watch closely and give extra care to help patients feel well during treatment.
Palliative Care and Supportive Approaches
In some cases, especially when liver function is poor and the disease is advanced, the focus turns to comfort. Instead of fighting the tumour, doctors work to ease pain, reduce symptoms, and give emotional help. Treatment may include pain control, easing swelling (ascites) and jaundice, giving good nutrition, and planning for end-of-life care. This phase of treatment of liver cancer helps patients stay comfortable and respected.
Another key part of liver cancer care is clinical trials. These studies test new treatments and may be a good option for patients when standard treatments stop working. Clinical trials also help move cancer research forward, which benefits future patients.
Lifestyle Support and Final Thoughts on Treatment of Liver Cancer
Good habits can help the liver and improve treatment results. Patients should stop drinking alcohol, avoid harmful medications, eat healthy meals, and control other health problems like diabetes or high blood pressure. Vaccines and antiviral treatment for hepatitis are also important parts of care.
Moving Forward with the Treatment of Liver Cancer
In summary, the treatment of liver cancer includes many types of care, both to cure and to comfort. Surgery, transplant, drug therapies, and support all play a part. The best plan depends on how far the cancer has spread, how well the liver works, and what the patient prefers. With better science and a growing focus on early detection and personal care, people living with liver cancer have more hope for a better and longer life.
