If treated early enough, hepatocellular carcinoma, which is also called liver cancer, may be curable. Treatment for hepatocellular carcinoma depends on the stage of the cancer.

Stages are used to describe how much the cancer has worsened or spread.

Stages and Treatments

Stages and treatments for hepatocellular carcinoma are:

Stage 0 – This is a very early stage of hepatocellular carcinoma.

Treatment for Stage 0 hepatocellular carcinoma may include watching and waiting; partial or total hepatectomy, which is part or full surgical removal of the liver; liver transplant; radiofrequency ablation, which uses heat to destroy cancer cells; microwave therapy, which uses high levels of heat to destroy cancer cells; percutaneous ethanol injection, which uses alcohol to kill tumors; and cryoablation, which uses extreme cold to kill cancer cells.

Stage A – This is an early stage of hepatocellular carcinoma.

Treatment for Stage A hepatocellular carcinoma may include watching and waiting; partial or total hepatectomy, which is part or full surgical removal of the liver; liver transplant; radiofrequency ablation, which uses heat to destroy cancer cells; microwave therapy, which uses high levels of heat to destroy cancer cells; percutaneous ethanol injection, which uses alcohol to kill tumors; and cryoablation, which uses extreme cold to kill cancer cells.

Stage B – This is an intermediate stage of hepatocellular carcinoma.

Treatment for Stage B hepatocellular carcinoma may include watching and waiting; partial or total hepatectomy, which is part or full surgical removal of the liver; liver transplant; radiofrequency ablation, which uses heat to destroy cancer cells; microwave therapy, which uses high levels of heat to destroy cancer cells; percutaneous ethanol injection, which uses alcohol to kill tumors; and cryoablation, which uses extreme cold to kill cancer cells.

Stage C – This is an advanced stage of hepatocellular carcinoma.

Treatment for Stage C hepatocellular carcinoma may include embolization therapy using transarterial embolization or transarterial chemoembolization. Embolization therapy makes clots form to stop the blood flow to tumors so they will die. Other treatments that may be used for Stage C hepatocellular carcinoma radiation therapy; targeted therapy with tyrosine kinase inhibitors, such as sorafenib; or immunotherapy.

Stage D – This is end-stage hepatocellular carcinoma.

Treatment for Stage D hepatocellular carcinoma may include embolization therapy using transarterial embolization or transarterial chemoembolization. Embolization therapy with or without chemotherapy makes clots form to stop the blood flow to tumors so they will die.

Other treatments that may be used for Stage D hepatocellular carcinoma radiation therapy, targeted therapy with tyrosine kinase inhibitors, or immunotherapy.

For more advanced, unresectable, or end-stage hepatocellular carcinoma, stereotactic body radiotherapy; Cyberknife image-guided radiation therapy; and intensity-modulated radiation therapy, where several beams of radiation are directed at the liver cancer, may be used.

Types of Treatments

Surgery (Resection) – In patients whose liver is working normally, early-stage hepatocellular carcinoma may be successfully treated with partial or full removal of the affected area of the liver, which is called hepatectomy. A small amount of healthy tissue surrounding the cancer may also be removed.

Ablation therapy – Ablation therapy comes in many forms, such as cryoablation, ethanol ablation, radiofrequency, or microwave ablation, and uses extreme hot or cold to kill cancer cells and destroy tumors. Ablation therapy may be an option for patients with hepatocellular carcinoma that cannot be treated with surgery, or for patients that are too frail to undergo surgery. Ablation therapy is less likely to provide a cure than surgery.

Chemotherapy (Chemoembolization, Embolization) – Regular chemotherapy with doxorubicin, 5-flouracil, and cisplatin is only used to reduce the tumor size in some patients with hepatocellular carcinoma because liver tumors tend to resist chemotherapy.

Trans-arterial chemoembolization is a procedure where a catheter is inserted through blood vessels into the liver through which chemotherapy drugs are delivered directly to the liver tumor.

Embolization, such as chemoembolization, arterial embolization, and radioembolization, blocks the blood supply to the tumors with the use of chemotherapy, small particles, or radioisotopes, and may be used when surgery or ablation are not possible.

Radiation therapy – Stereotactic body radiotherapy, Cyberknife, image-guided radiation therapy, and intensity-modulated radiation therapy, where several beams of radiation are directed at the liver cancer, may be used to treat more advanced, unresectable, or end-stage hepatocellular carcinoma.

Targeted drug therapy – Targeted drug therapy, such as the drug, sorafenib, which attacks cancer cells’ ability to reproduce and survive, may be used in advanced hepatocellular carcinoma to slow the progress of the disease.

Immunotherapy – Immunotherapy drugs (immune checkpoint inhibitors) enlist the body’s immune system to kill the cancer cells and may be used to treat advanced hepatocellular carcinoma.

Liver transplant – In early hepatocellular carcinoma that has not spread, which is called metastasis, the diseased portion of the liver may be surgically removed and replaced with a donor liver. However, liver transplants may only be offered to select patients. A liver transplant may be used if the tumor is small and has not spread to nearby blood vessels, or if the tumor cannot be surgically removed. Liver transplant may be performed using only a section of a living donor liver which can regenerate within a few weeks. Liver transplantation carries risks of complications from surgery and organ rejection, in addition to potential side effects from immunosuppressive medications that must be taken for life.

Palliative care

If the hepatocellular carcinoma is cannot be removed with surgery or has spread, a cure is unlikely, in which case, palliative care, which is designed to improve the patient’s quality of life, is recommended. Palliative care focuses on relieving pain and symptoms, providing support, and making a patient comfortable.

Experimental/Future therapies

Experimental and future therapies for the treatment of hepatocellular carcinoma include trans-arterial chemoembolization with drug-eluting beads; systemic treatment with multi-kinase inhibitors, such as levatinib, regorafenib, and cabozantinib; immunotherapy with immune checkpoint inhibitors, such as tremelimumab, ramucirumab, nivolumab and pembrolizumab; combination therapies with atezolizumab and bevacizumab; and combination systemic therapies, including lenvatinib and pembrolizumab, cabozantinib and atezolizumab, sintilimab and IBI305, and apatinib and SHR1210.

Sources

This content was written by the MediFind Medical Team. Last updated: 6/9/2022