Managing Early Stager Liver Cancer
- Early-stage liver cancer is usually a disease called hepatocellular carcinoma (HCC), which has effective treatment options with a potential for cure.
- Treatment plans are personalized, considering the cancer stage, patient health, and care goals — and focus on the best outcome.
- Doctors use tests to assess liver function and guide treatment choices, with surgery being a primary option for early-stage cancer.
- Surgical approaches include open surgery and minimally invasive techniques. Your care team may also consider other treatments including ablation (a cancer destroying technique) and emerging treatments like targeted drug therapy, and immunotherapy to rev up the body’s immune system.
With the right approach, you can navigate your diagnosis with your doctor to find the most effective options and potentially even a cure.
Read MoreWhat is early stage liver cancer?
The type of liver cancer detected in its early stages is usually the disease known as Hepatocellular carcinoma (HCC).HCC is the most common form of primary liver cancer, meaning that the cancer originated within the liver.
Early-stage liver cancer is cancer that is just in the liver and has not spread to other parts of the body. At this point, tumors are often smaller and have not yet invaded the blood vessels or surrounding tissues.
Dr. Kinkhabwala explained to SurvivorNet that doctors recommend treatment based on several factors.
“We kind of individualized treatment based on a few factors. Stage is definitely an important consideration in deciding the best treatment. So an earlier stage cancer may be appropriate for something like surgical resection. However, there’s other factors also such as the patient’s, their medical comorbidities and what their goals are in care,” he says.
When doctors refer to the cancer as “early stage” it means that the cancer falls into stage 0, I, or II according to the staging systems doctors use to understand how advanced your cancer is. These stages are determined based on a system known as TMN.
- (T) Assesses tumor size
- (M) Determines whether the cancer has spread to nearby lymph nodes, small, bean-shaped glands that help fight infections.
- (N) Looks at whether or not the cancer has metastasized, or spread, to other parts of the body.
Detecting liver cancer at this stage significantly increases the chances of successful treatment and long-term survival, Dr Kinkhabwala says, although catching this cancer early can be challenging, as symptoms often don’t appear until the cancer has progressed to a more advanced stage.
However, regular monitoring and screening in high-risk individuals—such as those with chronic viral infection known as hepatitis B or C, cirrhosis (scarring of the liver), or a family history of liver cancer—can help catch the disease in its early stages, when treatment is most effective.
Underlying liver function and patient status
Another very important factor that helps doctors chose a treatment, is the state of liver function. The Child-Pugh classification system helps doctors assess the severity of liver disease, particularly cirrhosis, which is a scarring of the liver that hurts its function. Assessing how well the liver is working helps them understand whether surgery is the right treatment choice.
The Child-Pugh system evaluates five main factors:
- Bilirubin levels: Bilirubin is a yellow substance produced when the liver breaks down old blood cells. High levels can indicate liver problems.
- Albumin levels: A protein made by the liver. Low levels can suggest liver damage.
- INR (International Normalized Ratio.): This measures how long it takes for blood to clot. Liver damage can affect clotting time, leading to a longer INR.
- Ascites: Ascites is a buildup of fluid in the abdomen, which can occur in advanced liver disease.
- Hepatic encephalopathy: This refers to mental confusion or changes in consciousness due to liver dysfunction.
Based on these factors, doctors assign a score for each, ranging from 1 to 3, with 3 being the most severe. The scores are then added together to give an overall Child-Pugh score.
The Child-Pugh classification divides patients into three main categories:
- Category A indicates mild liver disease, or well-compensated disease (score of 5 to 6)
- Category B suggests moderate disease (score of 7 to 9)
- Category C indicates severe liver disease, or decompensated disease (score of 10 to 15)
These classes correlate with a predicted one- and two-year patient survival: class A: 100 and 85%; class B: 80 and 60%; and class C: 45 and 35%.
This classification helps doctors decide on the best treatment options and predict a patient’s prognosis.
Related: Understanding the Basics of Liver Cancer
Early stage treatment: surgery
The backbone of early liver cancer treatment is surgery. Doctors will strongly consider surgery for early liver cancer, particularly when the tumor is confined to the liver and hasn’t spread. If the circumstances are right, surgery offers the best chance for a cure.
“Primarily we would like to remove the liver tumor if possible,” Dr. Elliot Newman, chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, tells SurvivorNet.
“These curative pathways can include surgery, so sometimes we’ll do resection where we actually operate on the patient and remove part of the tumor along with the liver. The medical term for this is partial hepatectomy, which is considered curative in small lesions,” adds Dr.Kinkhabwala.
There are two main types of surgery doctors will consider to operate on liver cancer: open and minimally invasive
Open surgery
Traditional open surgery involves making a large incision (cut into the body) so your doctor can directly access and treat the affected area.
Open surgery offers clear visibility and space for the surgeon to operate.
Though it has risks, including a longer recovery period, it’s considered a good option for complex or large-scale procedures. However, it is riskier and means a longer, potentially more painful recovery period.
There are two methods of open surgery:
- Traditional Liver Resection: This is used for more complex cases. The surgeon makes a large incision to remove the part of the liver that contains the tumor.
- Liver Transplantation: When the liver is very damaged by cancer and other treatments won’t work, your doctor may recommend a full liver transplant which replaces the diseased liver with a healthy one from a donor.
Minimally invasive surgery
Doctors use tools like tiny cameras and small surgical instruments inserted through small cuts in the skin to remove liver cancer or destroy tumors without making large incisions.
Minimally invasive surgical techniques include laparoscopy where the surgeon makes only tiny cuts, or incisions, to remove the cancer.
“We certainly see benefits in minimally invasive surgery when it’s possible because patients have smaller incisions and can recover more quickly and get out of the hospital more quickly and get back to full functionality more quickly,” explains Dr. Newman.
Considerations for either open and minimally invasive surgeries include the size and location of the tumor, number of tumors, overall liver functions, and the health of the patient.
Other treatment options
“There’s also nonsurgical techniques such as ablation where radiologists can actually insert a needle into the tumor using imaging guidance and burn the tumor. And then there are many other treatments that are now just emerging such as stereotactic radiosurgery, which can also be used for small tumors,” says Dr Kinkhabwala.
Ablation therapies are treatments used to destroy cancer cells in the liver without the need for surgery.
Radiofrequency ablation (RFA), uses heat generated by high-frequency electrical currents to destroy cancer cells. During this kind of procedure, the doctor will insert a thin needle-like probe directly into the tumor. The probe then emits radiofrequency energy, heating and killing the cancer cells.
These therapies are typically performed using imaging techniques such as ultrasound or CT scans to precisely target the tumor and monitor the treatment process. Most patients can have them under local anesthesia and can often go home the same day.
Ablation therapies are considered safe and effective. Patients usually have less pain and a quicker recovery time compared to surgery.
However, Guidelines from the American Association for the Study of Liver Diseases suggest surgery over RFA for adults with Child-Pugh class A cirrhosis and early staged tumors such as T1 or T2 .
Consensus-based guidelines from the National Comprehensive Cancer Network (NCCN) also state that resection is preferred over nonsurgical therapies, when possible.
Additionally, in certain situations your doctor may also incorporate a certain type of medication into your treatment, especially if surgery is not an option for you.
While traditional chemotherapy has been less effective for liver cancer, targeted therapy drugs like sorafenib (Nexavar) have shown promise in treating HCC by specifically stopping the cancer cells from growing and spreading.
Additionally, recent advances in immunotherapy, treatments that boost the body’s immune system to fight cancer, have also shown promise. Drugs such as nivolumab (Opdivo) and pembrolizumab (Keytruda) are approved for use in certain cases of HCC.
These treatments may be considered for early-stage liver cancer to downsize tumors before surgery or to address cancer that cannot be removed completely, aiming to improve survival and quality of life for patients.
Related: Singer Michael Buble’s Eldest Son Beat Liver Cancer
Questions for your doctor
- What stage is my cancer?
- What are my treatment options?
- Am I eligible for surgery?
- What results can I expect from treatment?
- What side effects can I expect from treatment?
- What part of my care will be covered by insurance and how much can I expect to pay out of pocket?
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