Liver cancer can be treated in several ways, but the most suitable approach may not be immediately clear from the diagnosis alone. The options considered may differ between patients, as treatment decisions take into account both the cancer and the condition of the liver.
Doctors bring together information about the tumour, liver function and the patient's overall health when considering the available options. Understanding how these factors shape treatment decisions can help patients make better sense of their recommendations and what the next steps may involve.
What Do Doctors Assess Before Recommending Liver Cancer Treatment?
Selecting a liver cancer treatment begins with a detailed assessment of both the cancer and the patient. A few key factors, such as the tumour's characteristics, liver function and overall health, help guide which treatment options may be appropriate.
The Type and Extent of the Cancer
Doctors first determine the type of liver cancer present. Hepatocellular carcinoma and intrahepatic cholangiocarcinoma arise from different cells and may require different treatment approaches. Cancer that has spread to the liver from another organ is also managed differently from cancer that began in the liver.
CT or MRI scans help establish whether the cancer is confined to the liver, involves nearby blood vessels or has spread to lymph nodes or distant organs. These findings help doctors determine the stage of the disease and whether treatment should target the liver alone or cancer cells elsewhere in the body.
The Number, Size and Location of the Tumours
A single, accessible tumour may be more suitable for surgical removal or ablation than several tumours affecting different parts of the liver. However, size and number are not considered in isolation.
The tumour's position is equally important. Doctors assess whether it lies near major blood vessels, bile ducts or other structures that could make treatment more complex.
The Condition and Function of the Liver
Many people with primary liver cancer also have cirrhosis, chronic hepatitis or another underlying liver condition. This means doctors must assess not only whether the cancer can be treated but also whether the remaining liver can continue functioning adequately afterwards.
Blood tests, imaging findings and signs of complications such as fluid accumulation or portal hypertension may be reviewed. A patient with well-preserved liver function may be able to tolerate an operation that would carry greater risks for someone with more advanced liver disease.
The Patient's Overall Health and Treatment Fitness
Doctors also consider the patient's general health, mobility and ability to manage the demands of treatment and recovery. Heart or lung disease, kidney problems and other medical conditions may affect whether surgery or certain medications can be used safely.
How Do These Factors Affect Which Treatments Are Suitable?
Once the assessment is complete, doctors compare the available treatments with the patient's individual circumstances.
Liver Resection or Liver Transplantation
Surgery may be considered when the cancer can be treated without leaving the patient with insufficient liver function. The main surgical options include:
Liver Resection
Liver resection removes the tumour together with part of the surrounding liver. It may be suitable when the cancer is confined to a removable area, has not spread and enough healthy liver can remain after surgery.
Liver Transplantation
Liver transplantation replaces the entire liver and may treat both selected tumours and the underlying liver disease. Eligibility depends on the tumour's size and number, whether the cancer has spread, the patient's overall health and the availability of a suitable donor liver.
Tumour Ablation and Liver-Directed Treatments
Some treatments target the tumour while preserving more of the surrounding liver. Options may include:
Tumour Ablation
Uses techniques that destroy cancer cells directly within the tumour. It may be considered for selected smaller tumours when surgery is unsuitable or would require removing too much healthy liver.
Transarterial Chemoembolisation
Delivers chemotherapy directly to the tumour and reduces its blood supply.
Radioembolisation
Delivers small radioactive particles through the blood vessels supplying the tumour.
The suitability of these treatments depends on the tumour's size, location and distribution, as well as the condition of the liver and its blood vessels.
Radiotherapy and Treatments That Work Throughout the Body
Some treatments focus on a particular tumour in the liver, while others travel through the bloodstream to reach cancer cells in different parts of the body. Depending on the cancer's type and extent, options may include:
Radiotherapy
Uses targeted radiation to control selected liver tumours when surgery or ablation is unsuitable.
Immunotherapy
Uses medicines that help the immune system recognise or respond to cancer cells.
Targeted Therapy
Acts on specific pathways that cancer cells use to grow or survive.
Chemotherapy
Uses medicines that act against cancer cells and may be considered for certain types and stages of liver cancer.
Systemic treatments may be considered depending on the type and extent of the cancer, including when disease has spread beyond the liver. Radiotherapy may be used in selected circumstances as a local treatment.
Why May Two Patients Receive Different Liver Cancer Treatment Plans?
Treatment recommendations reflect the combined effect of multiple clinical factors. Even when two patients appear to have a similar diagnosis, differences in tumour position, liver reserve or general health can lead to different plans.
Balancing Cancer Control With Preserving Liver Function
The aim of treatment is not only to address the cancer but also to preserve enough functioning liver where possible. Doctors therefore consider the extent of treatment alongside the risk of liver failure and other complications.
Adjusting Treatment According to the Patient's Response
A treatment plan may change as new information becomes available. Follow-up scans, blood tests, treatment side effects and changes in liver function help doctors determine whether the current approach remains appropriate.
Response to treatment may sometimes affect whether additional treatment options can subsequently be considered. If the cancer progresses or the patient's health or liver function changes, the treatment plan may also need to be adjusted.
Discuss Your Liver Cancer Treatment Options With Dr Wong Jen San
The most appropriate liver cancer treatment depends on more than the cancer's stage. Its type, location and extent must be considered alongside liver function, overall health and the patient's ability to tolerate treatment. A thorough assessment can help identify which options may be appropriate and how they may be combined or sequenced.
Hepatobiliary & Pancreatic Surgery Centre provides assessment and treatment planning for patients with liver and other hepatobiliary conditions. Dr Wong Jen San is a consultant hepatobiliary and pancreatic surgeon with experience in liver surgery, liver transplantation and multidisciplinary cancer care. If you have been diagnosed with liver cancer or would like to understand your available treatment options, contact the clinic to arrange a consultation.
FAQs About Liver Cancer Treatment
Meet Dr Wong Jen San
Dr Wong Jen SanConsultant Hepatobiliary & Pancreatic SurgeonMBChB (UK), MMed (S'pore), MSc (S'pore), FRCS (Edin), FAMS
Dr Wong Jen San is a consultant hepatobiliary and pancreatic surgeon with expertise in the diagnosis and surgical management of conditions affecting the liver, pancreas, gallbladder, bile ducts and digestive system. His clinical interests include hepatobiliary and pancreatic surgery, minimally invasive and robotic surgery, liver transplantation, gastrointestinal surgery, endoscopy and general surgical procedures. Dr Wong is committed to providing evidence-based, patient-centred care tailored to each individual's condition and treatment needs.
is a Complex and Intricate One
