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Liver cancer, also known as hepatocellular carcinoma (HCC), is a serious condition that requires a tailored treatment approach based on the stage of the cancer, the patient’s overall health, and liver function. Treatment options range from surgery and localized therapies to systemic treatments and palliative care. Here’s a comprehensive guide to treating liver cancer:

1. Surgical Treatments

A. Liver Resection (Surgical Removal of the Tumor)

• When it’s used: For early-stage liver cancer when the tumor is small and confined to one part of the liver, and the liver function is good.
• Benefits: Can potentially cure the cancer if completely removed.
• Risks: Bleeding, infection, and liver failure (especially in patients with cirrhosis).

B. Liver Transplant

• When it’s used: For patients with early-stage liver cancer who are not candidates for resection due to poor liver function (e.g., cirrhosis).
• Criteria: Typically follows the Milan Criteria(single tumor ≤5 cm or up to 3 tumors ≤3 cm each, with no spread outside the liver).
• Benefits: Removes the cancer and replaces the diseased liver.
• Challenges: Limited availability of donor organs and the need for lifelong immunosuppression.

2. Localized Treatments

These treatments target the tumor directly without removing it surgically.

A. Ablation Therapy

• Methods:
  • Radiofrequency Ablation (RFA): Uses heat to destroy cancer cells.
  • Microwave Ablation: Uses microwave energy to kill cancer cells.
  • Cryoablation: Freezes and destroys cancer cells.
• When it’s used: For small tumors (usually <5 cm) in patients who cannot undergo surgery.
• Benefits: Minimally invasive with fewer side effects.

B. Transarterial Chemoembolization (TACE)

• What it involves: Delivers chemotherapy directly to the tumor through the hepatic artery, followed by blocking the artery to cut off blood supply.
• When it’s used: For intermediate-stage liver cancer or as a bridge to transplant.
• Benefits: Targets the tumor while sparing healthy liver tissue.

C. Radioembolization (Yttrium-90 Therapy)

• What it involves: Injects tiny radioactive beads into the hepatic artery to deliver radiation directly to the tumor.
• When it’s used: For tumors that cannot be surgically removed or ablated.
• Benefits: Minimally invasive with fewer systemic side effects.

3. Radiation Therapy

• Stereotactic Body Radiation Therapy (SBRT):
  • Delivers high doses of radiation precisely to the tumor.
  • Used for small tumors or when other treatments are not feasible.
• Proton Beam Therapy:
  • A type of radiation that minimizes damage to surrounding healthy tissue.
  • Suitable for localized tumors.

4. Systemic Treatments

These treatments are used when the cancer has spread beyond the liver or is not amenable to localized therapies.

A. Targeted Therapy

• Drugs:
  • Sorafenib (Nexavar): First-line treatment for advanced liver cancer.
  • Lenvatinib (Lenvima): Alternative to sorafenib.
  • Regorafenib (Stivarga): For patients who progress after sorafenib.
  • Cabozantinib (Cabometyx): For advanced liver cancer.
• How they work: Block the growth and spread of cancer cells by targeting specific molecules.

B. Immunotherapy

• Drugs:
  • Atezolizumab + Bevacizumab: First-line immunotherapy combination for advanced liver cancer.
  • Nivolumab (Opdivo): Used in advanced cases.
  • Pembrolizumab (Keytruda): For patients who have progressed on other treatments.
• How they work: Boost the immune system to recognize and attack cancer cells.

C. Chemotherapy

• When it’s used: Less commonly for liver cancer, but may be used in combination with other treatments.
• Drugs: Doxorubicin, cisplatin, or gemcitabine.

5. Palliative Care

• When it’s used: For advanced liver cancer to manage symptoms and improve quality of life.
• Focus: Pain relief, nutritional support, and emotional well-being.

6. Lifestyle and Supportive Care

• Nutrition: A balanced diet to support liver function and overall health.
• Avoid Alcohol: To prevent further liver damage.
• Vaccinations: Ensure vaccination against hepatitis A and B if not already immune.
• Support Groups: Emotional and psychological support for patients and caregivers.

Treatment by Stage

• Early-Stage (Localized):
  • Surgery (resection or transplant), ablation, or radiation therapy.
• Intermediate-Stage:
  • TACE, radioembolization, or systemic therapy.
• Advanced-Stage (Metastatic):
  • Targeted therapy, immunotherapy, or palliative care.

Follow-Up and Monitoring

• Regular imaging (CT, MRI, or ultrasound) and blood tests (AFP levels) to monitor for recurrence.
• Management of underlying liver disease (e.g., hepatitis B or C, cirrhosis).

Key Considerations

• Liver Function: Treatment options depend on how well the liver is functioning.
• Underlying Liver Disease: Managing conditions like hepatitis or cirrhosis is crucial.
• Multidisciplinary Approach: Collaboration between hepatologists, oncologists, surgeons, and radiologists is essential for optimal care.

Liver cancer treatment has advanced significantly in recent years, offering hope for improved outcomes. Early detection and a personalized treatment plan are critical. If you or a loved one is diagnosed with liver cancer, consult a specialized cancer center to explore the best treatment options.