Dr. Anjana Pillai 

Dr. Anjana Pillai explains, in an interview with CURE, that treatment for liver cancer depends heavily on stage, liver function and a person’s overall health. For those diagnosed at very early or early stages, options may include surgery, liver transplant or local therapies such as ablation or catheter-based treatments that directly target tumors.  As disease becomes more advanced, patients may still receive local regional therapy depending on how widespread the cancer is. When the cancer has spread or liver function declines, systemic therapies are the standard, and more effective options have become available in recent years. Pillai is a professor of medicine and surgery and leader of multiple liver programs at UChicago Medicine. Transcript: What are the main treatment options available now for liver cancer? When we talk about liver cancer staging, there are several systems, but most of us use the BCLC staging system — the Barcelona Clinic Liver Cancer system. It divides patients into stages of disease, and importantly also considers liver function and a person’s overall functional status. Very-early stage means a single, very small lesion (2 centimeters or less), excellent liver function and full functionality. These patients have the most options: surgical resection, certain local regional therapies — such as radiofrequency ablation or microwave ablation to heat the tumor — or SBRT, a radiation-based therapy. Liver transplant can also be an option in this group. Early stage, or stage A, includes a single tumor or up to three tumors that are each 3 centimeters or less, again with well-preserved liver function. These patients may still qualify for resection depending on liver health and tumor location. They can also receive local regional therapies such as chemoembolization beads or radiation embolization beads, which are catheter-delivered. Liver transplant remains an option as well. Deciding between surgery, transplant or an ablative or catheter-based therapy should involve a multidisciplinary discussion focused on the best plan for the patient. Intermediate stage, BCLC B, typically includes patients with multifocal tumors. Some may be “downstaged” to become eligible for transplant if the tumors are still well-defined. Others may have more diffuse or infiltrative tumors involving both sides of the liver, which makes the stage very heterogeneous. Some patients might still have curative options like transplant, while others are better suited for systemic therapies. Local regional therapy — like the chemoembolization or radioembolization beads — can still be used depending on tumor size, number and location. And throughout all these stages, preserved liver function and functional status remain key. More advanced stage, BCLC C, usually means the cancer has entered the blood vessels or spread outside of the liver — metastatic disease — or the patient has poorer performance status. Even if the tumor burden is earlier stage, worse functional status can place someone in BCLC C. These patients typically receive systemic therapy. And while it is never a good time to have cancer, we now have many more systemic treatment options for liver cancer than we did even 10 years ago, including several available beyond the first line. Transcript has been edited for clarity and conciseness. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.

What Are My Options for Liver Cancer Treatment?

Dr. Anjana Pillai explains, in an interview with CURE, that treatment for liver cancer depends heavily on stage, liver function and a person’s overall health. For those diagnosed at very early or early stages, options may include surgery, liver transplant or local therapies such as ablation or catheter-based treatments that directly target tumors.

As disease becomes more advanced, patients may still receive local regional therapy depending on how widespread the cancer is. When the cancer has spread or liver function declines, systemic therapies are the standard, and more effective options have become available in recent years.

Pillai is a professor of medicine and surgery and leader of multiple liver programs at UChicago Medicine.

What are the main treatment options available now for liver cancer?

When we talk about liver cancer staging, there are several systems, but most of us use the BCLC staging system — the Barcelona Clinic Liver Cancer system. It divides patients into stages of disease, and importantly also considers liver function and a person’s overall functional status.

Very-early stage means a single, very small lesion (2 centimeters or less), excellent liver function and full functionality. These patients have the most options: surgical resection, certain local regional therapies — such as radiofrequency ablation or microwave ablation to heat the tumor — or SBRT, a radiation-based therapy. Liver transplant can also be an option in this group.

Early stage, or stage A, includes a single tumor or up to three tumors that are each 3 centimeters or less, again with well-preserved liver function. These patients may still qualify for resection depending on liver health and tumor location. They can also receive local regional therapies such as chemoembolization beads or radiation embolization beads, which are catheter-delivered. Liver transplant remains an option as well. Deciding between surgery, transplant or an ablative or catheter-based therapy should involve a multidisciplinary discussion focused on the best plan for the patient.

Intermediate stage, BCLC B, typically includes patients with multifocal tumors. Some may be “downstaged” to become eligible for transplant if the tumors are still well-defined. Others may have more diffuse or infiltrative tumors involving both sides of the liver, which makes the stage very heterogeneous. Some patients might still have curative options like transplant, while others are better suited for systemic therapies. Local regional therapy — like the chemoembolization or radioembolization beads — can still be used depending on tumor size, number and location. And throughout all these stages, preserved liver function and functional status remain key.

More advanced stage, BCLC C, usually means the cancer has entered the blood vessels or spread outside of the liver — metastatic disease — or the patient has poorer performance status. Even if the tumor burden is earlier stage, worse functional status can place someone in BCLC C. These patients typically receive systemic therapy. And while it is never a good time to have cancer, we now have many more systemic treatment options for liver cancer than we did even 10 years ago, including several available beyond the first line.

Transcript has been edited for clarity and conciseness.

For more news on cancer updates, research and education,

don’t forget to subscribe to CURE®’s newsletters here.

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Dr. Anjana Pillai says treatment depends on stage and health, with surgery, transplant, local therapy or systemic drugs to help people live longer.

During Liver Cancer Awareness Month, Dr. Anjana Pillai says more treatment options, growing trials and ongoing research offer hope for patients.

Advancing Research Offers Hope for Patients With Liver Cancer

As October marks Liver Cancer Awareness Month, experts highlight encouraging progress in treatment and research.

Dr. Anjana Pillai, professor of medicine and surgery and leader of multiple liver programs at UChicago Medicine, explained that although a diagnosis of liver cancer can be incredibly difficult, there is reason for hope — especially as research continues to advance.

If liver cancer is detected early, patients have more treatment paths to consider than ever before. Even in more advanced cases, Pillai noted that treatment options have expanded significantly for both hepatocellular carcinoma and cholangiocarcinoma. Clinical trials are increasing, therapies are evolving and new drug types — including systemic and local regional options — are being actively explored.

Pillai emphasized that continued momentum in research and treatment development offers optimism for patients living with or beyond liver cancer today.

What gives you specifically hope for patients living with or beyond liver cancer today?

Yeah, you know what I tell everyone, let's just acknowledge this sucks, right? You can't sugarcoat what it is, but if we're lucky enough to find it early, then I say, “OK, here are all our options.” And these are so many more options than we ever had. If we're not lucky and we found it more advanced, again, like I said, there are so many more treatments than ever before, and especially in both cancers, HCC and cholangiocarcinoma, the number of trials and treatments for these cancers have really exploded.

So as horrible as it is to have cancer and to deal with all the emotional and mental distress of it and the physical distress of liver disease, it is a time where research is really peaking and continues to, and where clinical trials are continuing, and more and more drugs are, being explored, and even different types, not just when I say therapies, not just systemic therapy, but local regional therapies and other types of options.

Dr. Anjana Pillai of UChicago Medicine explains liver cancer staging.

What Does Staging Mean in Liver Cancer?

Dr. Anjana Pillai, professor of medicine, as well as surgery, and leader of multiple liver programs at UChicago Medicine, explains that staging plays a key role in determining the best treatment for patients with liver cancer 

Once imaging confirms a diagnosis, doctors assess the size, number and location of tumors, as well as whether they involve major blood vessels or bile ducts. Additional tests, such as a CT scan of the chest, help determine if the cancer has spread beyond the liver, most commonly to the lungs or bones.

Together, this information forms the basis of staging, which helps clinicians understand how advanced the cancer is and what treatment options are most appropriate. In some cases, such as hepatocellular carcinoma with classic imaging in patients with cirrhosis or chronic hepatitis B, a biopsy may not be necessary, but accurate staging remains essential for guiding care.

Why is staging important for patients with liver cancer?

If it looks like someone has a primary liver cancer — and I know we’ll talk more about biopsies — some cancers, like HCC, don’t always need one if the imaging characteristics are very classic, especially in someone with cirrhosis or chronic hepatitis B. For most patients, though, a CT scan or MRI with contrast will show specific features that help confirm the diagnosis.

Once you’ve confirmed that, staging becomes important. Based on the size, number, and location of the tumors, and how far the cancer extends, you’ll also need additional testing — such as a CT scan of the chest — to make sure it hasn’t spread elsewhere. The bones and lungs are the most common places liver cancer can spread.

That’s what we mean by staging: determining the size and number of tumors, whether they invade major blood vessels or bile ducts, and checking if the cancer has spread outside the liver.

Dr. Anjana Pillai explains that staging liver cancer involves assessing tumor size, spread, and vessel involvement to guide treatment.

Dr. Anjana Pillai highlights Liver Cancer Awareness Month’s role in promoting liver health, dispelling myths and encouraging early detection and care.

What is the Importance of Recognizing Liver Cancer Awareness Month?

Dr. Anjana Pillai, professor of medicine and surgery and leader of multiple liver programs at UChicago Medicine, underscores the significance of recognizing Liver Cancer Awareness Month. She explains that the liver is a vital organ responsible for many functions necessary to sustain life, yet its remarkable reserve often masks early signs of disease until the liver is significantly damaged.

Public awareness is essential because liver disease is on the rise, and common misconceptions persist, such as the idea that only people who drink alcohol are at risk. Pillai highlights that there are many ways to protect liver health, from lifestyle choices to medical monitoring, and emphasizes the importance of early detection.

Awareness campaigns and dedicated months not only educate people about liver function and disease risk but also help dispel myths and encourage proactive health measures. She believes these efforts are critical in promoting liver health, supporting patients and addressing the growing prevalence of liver-related conditions.

What is the importance of recognizing Liver Cancer Awareness Month?

I love that we have a Liver Cancer Awareness Month. It should be every month... The liver is such an important organ. It does so many things that are necessary to sustain life. Most people don’t think about it because it has such great reserve that you really don’t notice problems until the liver is very sick. However, there are so many things we can do to take care of our liver. 

There are also many myths, like, “only people who drink alcohol get liver disease.” That’s not necessarily true at all. There are many ways we can stay aware of liver health. That’s why I think having these campaigns and awareness months should exist. And to be honest, there is a significant rise in liver disease in general. That’s important for people to know.

Dr. Anjana Pillai

What Are My Options for Liver Cancer Treatment?

Advancing Research Offers Hope for Patients With Liver Cancer

What Does Staging Mean in Liver Cancer?

What is the Importance of Recognizing Liver Cancer Awareness Month?

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