Treating Liver Cancer With A Tailored Approach Can Improve Results With Fewer Side Effects

“The diagnosis of liver cancer doesn’t mean that you’re going to die of liver cancer,” Dr. Milan M. Kinkhabwala, Professor of Surgery and Director of the Hepatobiliary section at the Montefiore Einstein Comprehensive Cancer Center, tells SurvivorNet. “All it means is that we need to make a correct diagnosis, stage the condition properly, and evaluate all the treatment options.

Dr. Kinkhabwala says that patients with early stage liver cancer that undergo treatment have a cure rate of 80% or higher.

“For sure that once the cancers are more advanced, it’s harder to cure,” he says. “But even with more advanced cancers, we have pretty aggressive treatments that are available to control or even shrink the cancer. Patients can have good survival rates even if their cancer is not totally cured.”

Related: SurvivorNet Guide to Immunotherapy

A tailored approach

One of the most important aspects of your care is ensuring that your treatment plan is tailored specifically to you. Every individual is different, and what works for one person may not be the best option for another. That’s why it’s important your doctor take the time to understand your medical history, preferences, and goals for treatment.

When developing your personalized treatment plan, physicians will consider a variety of factors, including:

• The stage of your cancer
• The size of the tumor
• The location of tumor
• Your overall health

Dr. Kinkhabwala explained to SurvivorNet that physicians should always tailor care for each patient.

“Individual care means that we consider many different factors in deciding the best treatment, including the stage of the cancer as well as the patient’s underlying condition. And also what the patient’s goals in terms of cancer therapy, how aggressive do they want to be and how much of an impact would the treatment have on the patient’s functional status and daily activities,” he says.

“Once we have a good picture of the patient’s goals as well as the stage and the complete medical history, we can come up with a very individualized and personalized plan of action,” he says.

This plan of action may include:

• A surgical approach
• More aggressive surgical options such as transplantation
• Less-invasive approaches such as ablation (a treatment that destroys liver cancer cells using heat, cold, or chemicals) or embolization (a procedure that blocks blood flow to cancer cells in the liver). Sometimes these two methods are combined with other treatments to improve our success rates
• Radiation Therapy
• The use of adjuvant (additional) treatments such as chemotherapy
• Targeted or immunotherapy that boosts the body’s natural defenses to fight cancer

“The main thing is that all patients that come to see us always have a multidisciplinary assessment, so they don’t only see a surgeon, they also see a medical oncologist and a specialist in liver disease called a hepatologist,” Dr. Kinkhabwala says. “The combination of these three doctors, the surgeon, the medical oncologist and a hepatologist (doctor who treats liver disease) work together to create the individual treatment plan.”

Throughout your treatment, keep an open communication with your care team. It’s essential that you to feel empowered and informed about your care decisions.

Related: Minimally Invasive Surgery in Liver Cancer 

Treatment options

Understanding what is available and what can meet your needs is important. Treatments your doctor may recommend might include one or more of the following:

Surgery

Surgery involves removing the cancerous tumor from the liver. It may be an option in earlier stage disease, especially if the tumor is small and has not spread beyond the liver.

“Primarily we would like to remove the liver tumor if possible,” Dr. Elliot Newman, the chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, tells SurvivorNet.

Types of liver surgery include partial hepatectomy, where a portion of the liver containing the tumor is removed, or liver transplant, where the entire liver is replaced with a healthy donor liver.

Ablation

Ablation for liver cancer uses heat, cold, or chemicals to destroy cancer cells directly without removing them surgically.

Doctors guide a needle to the tumor and then apply the treatment to target and kill the cancerous tissue.

This technique is less invasive, offers a quicker recovery, and is especially useful for small tumors or for patients who cannot undergo surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It can be given orally (in pill form) or through injections into a vein (IV).

Chemotherapy may be used before surgery to shrink the tumor, after surgery to kill any remaining cancer cells, or as a primary treatment if surgery is not an option.

Radiation Therapy

Radiation therapy uses high-energy rays to destroy cancer cells. It can be delivered externally using a machine outside the body or internally through tiny radioactive beads placed directly into the liver (known as radioembolization).

Radiation therapy may be used alone or in combination with other treatments to target liver tumors. Your healthcare team will determine the appropriate radiation therapy approach based on factors such as the size and location of the tumor and your overall health.

Targeted Therapy

Targeted therapy drugs specifically target cancer cells by blocking the signals that help them grow and spread. By honing in on these mutations, targeted therapy offers a more precise attack on cancer cells, sparing healthy tissue and reducing the overall side effects compared to conventional treatments.

These drugs are often used when standard chemotherapy is not effective or well-tolerated.

Sorafenib (Nexavar) is the most common targeted therapy drug used in liver cancer today. It works by blocking various ways that cancer cells grow to stop the cancer from spreading.

Targeted therapy may be recommended based on the results of genetic testing to identify specific mutations driving the growth of your cancer.

Immunotherapy

Immunotherapy works by boosting the body’s immune system to help fight cancer cells. It may be used alone or in combination with other treatments, particularly for advanced liver cancer.

Clinical Trials

Clinical trials offer access to new and innovative treatments that are not yet widely available. Participating in a clinical trial allows you to contribute to medical research while potentially receiving cutting-edge therapies.

Related: SurvivorNet Clinical Trail Finder

Types of liver cancer

There are two main stages of liver cancer: “primary,” which originates in the liver, and “secondary,” which spreads to the liver from other parts of the body.

Most liver cancers result from cancer that has spread from other parts of the body, known as secondary cancers. These secondary tumors are named after the original site where the cancer started. Cancers such as colon, breast, ovarian, and lung cancers, as well as melanomas, can spread to the liver.

The majority of primary liver cancers are hepatocellular carcinoma (HCC), which start in the main liver cells called hepatocytes. This cancer can develop as a single tumor and spread throughout the liver or arise in multiple cells across the liver.

Another important type of primary liver cancer is known as cholangiocarcinoma, also known as bile duct cancer, which begins in the cells lining the bile ducts, a network of tube-like structures that transport bile from the liver and gallbladder to the small intestine, aiding in digestion.

Questions to ask your doctor

• Am I eligible for surgery or for chemotherapy?
• What side effects can I expect and how will we manage them?
• Am I a good candidate for surgery? What types of surgery will you consider?
• What results can I expect?
• Am I eligible to receive targeted therapy? Am I more, or less, likely to respond to this treatment?
• What part of my treatment is covered by insurance and how much can I expect to pay out of pocket?
• Should I join a clinical trial?

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