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.

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.

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