This PDQ cancer information summary has current information about the treatment of adult primary liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
- What Is Liver Cancer?
Primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. Cancer that forms in other parts of the body and spreads to the liver is not primary liver cancer. The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage. The main functions of the liver include the following:
Types of liver cancer
Hepatocellular carcinoma and bile duct cancer (cholangiocarcinoma) are the main types of adult primary liver cancer.
Most adult primary liver cancers are hepatocellular carcinomas. This type of liver cancer is the third leading cause of cancer-related deaths worldwide.
Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults. For more information, see Childhood Liver Cancer.
Signs and symptoms of liver cancer
These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:
- How is liver cancer diagnosed?
Tests that examine the liver and the blood are used to detect and diagnose liver cancer. Every person will not receive all the tests described below.
The following tests and procedures may be used:
After primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process of determining the size and location of the cancer and whether it has spread is called staging.
Some of the tests and procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process. A positron emission tomography (PET) scan may also be used:
What affects liver cancer prognosis?
Once liver cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on the following:
Finding and treating liver cancer early may prevent death from liver cancer.
- Liver Cancer Stages
This page describes the stages of liver cancer for adults. The stage describes the extent of cancer in the body. Knowing the stage of liver cancer helps the doctor plan the best treatment.
To learn about liver cancer stages for children, see Stages of hepatoblastoma.
To learn about the tests and procedures used to diagnose and stage primary liver cancer, see Liver Cancer Diagnosis.
There are several staging systems for liver cancer. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used to stage primary liver cancer. The system is used to predict the patient’s chance of recovery and to plan treatment, based on the following:
The BCLC staging system has five stages:
For liver cancer in adults, stages are also grouped according to how the cancer may be treated:
To learn about other ways cancer stages can be described, see Cancer Staging.
To learn about treatment options, see Liver Cancer Treatment.
- Liver Cancer Treatment
There are different types of treatment for patients with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
Types of treatment
Surveillance is used for lesions smaller than 1 centimeter found during screening. Follow-up every 3 months is common. Surveillance is closely watching a patient’s condition but not giving any treatment unless there are changes in test results that show the condition is getting worse. During active surveillance, certain exams and tests are done on a regular schedule.
A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:
Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver. Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow.
The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.
There are two main types of embolization therapy:
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Targeted therapies used to treat advanced liver cancer include the following:
To learn more about targeted therapy and its side effects, see Targeted Cancer Therapies.
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
Immune checkpoint inhibitors are a type of immunotherapy. Immune checkpoint inhibitors that may be used to treat liver cancer include the following:
To learn more about immunotherapy and its side effects, see Immunotherapy to Treat Cancer and Immunotherapy Side Effects.
External radiation therapy uses a machine outside the body to send high-energy x-rays or other types of radiation toward the area of the body with cancer. This kills cancer cells or keeps them from growing. Certain ways of giving external radiation therapy can help keep radiation from damaging nearby healthy tissue:
To learn more about radiation therapy and its side effects, see Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects.
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be the best treatment choice.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
To learn more about clinical trials, see Clinical Trials Information for Patients and Caregivers.
Treatment of localized liver cancer
Treatment of localized liver cancer may include the following:
Treatment of locally advanced or metastatic liver cancer
Treatment of locally advanced or metastatic liver cancer may include the following:
Treatment of recurrent liver cancer
Treatment options for recurrent primary liver cancer may include the following: