Liver Cancer Treatment

Liver cancer occurs when abnormal cells grow within the liver. Primary liver cancer begins in the liver itself, while secondary (metastatic) liver cancer develops elsewhere and then spreads to the liver. Hepatocellular carcinoma—the most common type of primary liver cancer—is often associated with underlying liver disease, such as cirrhosis, hepatitis B or C or nonalcoholic fatty liver disease (NAFLD). A major risk factor is excessive alcohol consumption, which can contribute to liver damage and increase the risk of developing cirrhosis and liver cancer.

Although liver cancer is less common than many other types of cancer in the United States, it is still considered one of the more serious due to its often late diagnosis and underlying liver disease. According to the American Cancer Society, tens of thousands of new cases are diagnosed each year. Liver cancer affects more men than women and is typically diagnosed in individuals 60 or older, although it can occur earlier, especially in patients with chronic liver disease. Incidence rates are also higher in people with long-standing liver conditions, including those related to viral hepatitis, heavy alcohol use or metabolic conditions, such as obesity and diabetes.

In its early stages, liver cancer does not always produce symptoms, but as it progresses, it may cause abdominal pain or swelling, unexplained weight loss, jaundice, loss of appetite, fatigue or nausea. Because each case is unique, treatment decisions are based on several factors, including the tumor’s size, location and stage, as well as the patient’s overall health and liver function.

A comprehensive liver cancer treatment plan may include surgery, interventional radiology, chemotherapy, radiation therapy, immunotherapy and/or targeted therapy. One or more approaches may be combined to achieve the best possible outcome and quality of life.

Surgery for liver cancer

Surgery may offer a potential cure for some patients with liver cancer, particularly when the tumor is detected early and confined to the liver. However, it is a major procedure that requires careful consideration of the patient’s overall health, liver function and the potential risks involved.

Surgical treatment approaches for liver cancer include:

Liver resection

Also known as hepatectomy, liver resection may be an option if the tumor is small and localized and the remaining liver is healthy enough to function after surgery. During the procedure, the surgeon will remove the tumor along with a small margin of surrounding healthy tissue to help ensure complete cancer removal. Depending on the specifics of the case, the surgeon may use minimally invasive or robotic-assisted surgical techniques to enhance precision and support recovery.

Because many patients with liver cancer also have underlying liver disease, a thorough presurgical evaluation is essential to help ensure a safe and effective procedure. Potential risks of liver resection include:

• Bleeding
• Infection
• Bile leakage
• Reduced liver function or liver failure, particularly in patients with cirrhosis
• Complications related to anesthesia

The healthcare team will assess the patient’s liver function and overall health to determine whether resection is feasible.

Liver transplant

A liver transplant may be considered for a patient with advanced liver cancer or underlying cirrhosis that limits the liver’s ability to function. This approach will not only treat the tumor but also replace the damaged liver with a healthy one.

During the procedure, the surgeon will remove the diseased liver and replace it with a healthy donor liver. Once the new liver is in place, the surgeon will connect it to the surrounding blood vessels and bile ducts. Over time, the transplanted liver may adapt to the patient’s body and grow to meet its functional demands, allowing it to function normally.

Liver transplantation is a complex procedure that carries certain risks, including:

• Rejection of the donor liver
• Infection due to the immunosuppressive medications needed to prevent organ rejection
• Bleeding or blood clots
• Bile duct complications
• Side effects from lifelong immunosuppressive therapy

In addition, the patient must meet specific eligibility criteria and may need to wait for a suitable donor organ to become available. The healthcare team will carefully assess the patient’s overall health, liver function and tumor characteristics to determine whether a transplant is an appropriate option.

Interventional radiology (IR) for liver cancer

IR plays a critical role in modern liver cancer treatment, offering a minimally invasive, image-guided technique for targeting tumors directly. It may be used on a standalone basis or in combination with surgery and/or systemic therapy for heightened effectiveness.

Unlike traditional surgery, interventional radiology procedures are performed through the skin using imaging guidance, such as ultrasound, computed tomography (CT) or fluoroscopy. This approach allows for precise tumor targeting while minimizing disruption to surrounding healthy tissues.

Liver-directed therapies

Several interventional radiology techniques may be used to treat liver cancer by delivering therapy directly to the tumor or its blood supply. These approaches include:

• Transarterial chemoembolization (TACE) – Delivers chemotherapy directly into a tumor’s blood supply, then blocks the vessel to deprive the tumor of the oxygen and nutrients it needs to grow and survive
• Radiofrequency or microwave ablation – Uses heat to destroy tumor tissue through a probe inserted into the liver
• Yttrium-90 (Y-90) radioembolization – Delivers targeted radiation through tiny beads placed in the tumor’s blood vessels

While liver-directed therapies are generally well-tolerated and less invasive than surgery, these treatments are not without risks. Potential side effects and complications include:

• Pain or discomfort at the treatment site
• Fatigue, nausea or flu-like symptoms following treatment
• Infection or bleeding at the catheter or probe insertion site
• Damage to nearby healthy liver tissue or surrounding structures
• Changes in liver function, particularly in patients with underlying liver disease

Additionally, some patients may experience post-embolization syndrome after TACE, which may cause fever, abdominal pain and fatigue for several days.

Liver-directed therapy can be particularly beneficial for a patient who is not a candidate for surgery or who requires additional tumor control. The healthcare team will carefully evaluate the patient’s condition to determine which approach, if any, is most appropriate for their situation.

Chemotherapy for liver cancer

Chemotherapy uses powerful drugs to target and destroy rapidly dividing cells. After being administered intravenously or orally, the medications enter the bloodstream and circulate throughout the body to reach cancer cells wherever they may be. In addition to systemic chemotherapy, liver-directed approaches such as transarterial chemoembolization allow chemotherapy to be delivered directly to a liver tumor while limiting exposure to the rest of the body. The drug regimen can vary based on the type and stage of the cancer, as well as the patient’s overall health.

Because chemotherapy affects cancerous cells as well as healthy cells that naturally divide rapidly, it can cause a range of side effects, such as:

• Fatigue
• Nausea and vomiting
• Loss of appetite
• Hair loss
• Increased susceptibility to infection
• Easy bruising or bleeding
• Changes in liver function

During chemotherapy, the healthcare team will monitor the patient closely and may adjust the treatment plan or provide supportive therapies to help manage any side effects.

Although chemotherapy is not typically curative for liver cancer, it can help shrink a tumor before surgery, slow the progression of the disease or relieve discomfort and improve quality of life.

Radiation therapy for liver cancer

Radiation therapy is a localized treatment that uses high-energy beams, such as X-rays, to destroy cancer cells or inhibit their growth. It may be used before surgery to shrink a tumor and make it easier to remove, or as a supportive treatment to help relieve symptoms if surgery is not an option.

Because radiation therapy targets a specific tumor site, it can help preserve the surrounding healthy tissues. However, some nearby structures may still be affected, particularly in a sensitive organ like the liver. The healthcare team will carefully plan treatment to balance effectiveness with safety.

Types of radiation treatment for liver cancer include:

External beam radiation therapy (EBRT)

EBRT is the most common form of radiation therapy for liver cancer. The treatment involves the use of an external machine (linear accelerator), which delivers precisely targeted radiation beams to the tumor from outside the body. Through advanced planning techniques, the healthcare team can minimize radiation exposure to the surrounding healthy liver tissue. Despite its precision, however, EBRT may still cause side effects, such as:

• Fatigue
• Skin irritation in the treated area
• Nausea or loss of appetite
• Changes in liver function
• Radiation-induced liver disease (rare)

Side effects of external radiotherapy can vary depending on the dose and duration of treatment, as well as the patient’s overall health.

Brachytherapy

In some cases, brachytherapy may be used to deliver radiation internally to a liver tumor. This approach involves placing a small radioactive source directly into or near the tumor, allowing for a high dose of radiation to be concentrated in a specific area while limiting exposure to nearby tissues.

Because brachytherapy is more localized than EBRT, it may reduce some of the side effects typically associated with radiation therapy. However, potential risks still include:

• Discomfort or pain at the insertion site
• Bleeding or infection
• Local tissue irritation
• Damage to nearby structures, depending on the tumor location

The healthcare team will carefully evaluate the patient to determine whether radiation therapy is appropriate and, if so, which approach offers the best balance of safety and effectiveness.

Immunotherapy for liver cancer

Immunotherapy is an emerging treatment option that aims to help the body’s immune system recognize and attack cancer cells. Rather than targeting the tumor directly, it works by enhancing the immune system’s natural ability to detect and destroy cancer.

The most commonly used immunotherapy drugs for liver cancer are immune checkpoint inhibitors. These medications can block specific proteins, such as programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1), which cancer cells use to evade detection. By essentially “lifting the brakes” on the immune system, immunotherapy can help the body mount a stronger response against the cancer cells.

Immunotherapy may be used alone or in combination with other liver cancer treatments, depending on the patient’s specific diagnosis and treatment goals. While it has shown promising results in some cases, not all patients respond, and ongoing research continues to refine its use.

Because immunotherapy stimulates the immune system, it can sometimes cause the immune system to attack healthy tissues. Potential risks and side effects include:

• Fatigue
• Skin reactions, such as rash or itching
• Diarrhea or colitis
• Liver inflammation (hepatitis), which may affect liver function
• Hormonal changes due to inflammation of endocrine glands
• Lung inflammation (pneumonitis) in rare cases

These effects, often referred to as immune-related adverse events, can range from mild to severe. The healthcare team will monitor the patient closely throughout immunotherapy and may adjust the treatment plan or prescribe medications to help manage any adverse events.

Based on a thorough medical evaluation, the healthcare team can determine whether immunotherapy is an appropriate option and, if so, how it may fit into the patient’s overall liver cancer treatment plan.

Targeted therapy for liver cancer

Targeted therapy focuses on the specific molecular pathways and proteins involved in liver cancer growth and progression. By interfering with these complex biological processes, it can help slow or stop tumor growth while limiting damage to healthy cells.

Targeted therapy drugs work by inhibiting vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR) or mammalian target of rapamycin (mTOR), all of which play a key role in liver tumor growth, new blood vessel formation (angiogenesis) and metastasis. Medications such as sorafenib, lenvatinib, regorafenib and cabozantinib are commonly used to treat advanced hepatocellular carcinoma.

Because targeted therapy is designed to act on specific cancer-related mechanisms, it offers a more precise treatment approach than traditional chemotherapy. However, it can still affect normal cellular processes and cause side effects, such as:

• Fatigue
• High blood pressure
• Diarrhea
• Loss of appetite and weight loss
• Hand-foot skin reactions, such as redness, swelling or pain on the palms and soles
• Changes in liver function
• Increased risk of bleeding or blood clots

The type and severity of side effects can vary depending on the specific medication used and the patient’s overall health. The healthcare team will monitor the patient’s response closely and may adjust the treatment plan or provide supportive care to help manage any discomfort. This approach can help ensure that targeted therapy is used safely and effectively as part of a comprehensive liver cancer treatment plan.

Clinical trials for liver cancer

Clinical trials are essential for advancing the standard of care for liver cancer and improving patient outcomes and quality of life. These carefully designed research studies evaluate promising new therapies, treatment combinations and strategies for managing the disease.

In addition to assessing new treatments, clinical trials also play a key role in identifying cancer biomarkers, refining personalized treatment approaches and expanding the understanding of liver cancer biology. Participation in a clinical trial may provide access to innovative therapies that are not yet widely available, while also contributing to future advances in cancer care.

Benefit from world-class care at Moffitt Cancer Center

If you have been diagnosed with liver cancer, choosing the right cancer center is an important part of your treatment journey. In addition to offering the latest therapies, Moffitt has been actively involved in liver cancer studies for decades. Through our robust clinical trials program, many of our patients are among the first to benefit from innovative therapies not yet available elsewhere. In recognition of our notable research breakthroughs, the National Cancer Institute (NCI) has designated Moffitt a Comprehensive Cancer Center, a distinction that reflects our longstanding commitment to scientific leadership.

If you would like to explore your treatment options for liver cancer with a specialist in our Gastrointestinal Oncology Program, you can request an appointment by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.

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