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Liver Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find some basic information about liver cancer and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Liver Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the liver

The liver is a large organ located near the bottom of the rib cage on the right side of the body, above the stomach.

The liver is the largest internal organ in the body, and it is essential to live. It plays a key role in the digestion of food and medication. Liver functions include:

  • Collecting and filtering blood from the intestines

  • Processing and storing needed nutrients absorbed by the intestines

  • Converting some nutrients into energy or into substances needed to repair and build tissue

  • Producing some of the body’s blood-clotting factors

  • Removing toxins from the body

  • Helping maintain the proper sugar level in the body

About liver cancer

Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

This section only provides information about cancer that begins in the liver. This is known as primary liver cancer.

It is more common for cancer that started in another part of the body to spread to the liver. This is called metastatic cancer. Cancer that has spread to the liver from another part of the body is not liver cancer. Rather, it is based on where the cancer started. For instance, pancreatic, colon, stomach, breast, lung, or another type of cancer that has spread to the liver is still named according to the organ in which it started. This is important to note, as primary liver cancer is treated differently than metastatic cancer that started elsewhere and then spread to the liver. For more information about cancer that started in another part of the body and has spread to the liver, read about that specific cancer type.

Types of primary liver cancer in adults

There are several types of primary liver cancer that occur in adults. They are named for the type of cell from which the cancer develops.

Type of Liver Cancer

Description

How Common

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma can have different growth patterns. Some spread tentacle-like growths through the liver. This pattern is the most common one in the United States. Some start as a single tumor that spreads to other parts of the liver as the disease develops. Others develop as nodules at several different places in the liver. Occasionally, a pattern isn't clear.

Approximately 73% of primary liver cancers in adults are hepatocellular carcinomas.

Cholangiocarcinoma, also called bile duct cancer

A cholangiocarcinoma develops from cells in the bile duct of the liver. The bile duct is a thin tube that extends from the liver to the small intestine. The bile duct starts inside the liver as several smaller tubes that join together.

About 18% of primary liver cancers in adults are cholangiocarcinomas.

Angiosarcoma

Angiosarcoma starts in the blood vessels of the liver and grows very quickly.

About 1% of primary liver cancers in adults are angiosarcomas.

The rest of this section provides information on the most common type of adult primary liver cancer, hepatocellular carcinoma (HCC). For information about bile duct cancer and angiosarcoma, use the links in the chart above.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with liver cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Liver Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with liver cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with liver cancer?

In 2023, an estimated 41,210 adults (27,980 men and 13,230 women) in the United States will be diagnosed with primary liver cancer. Since 1980, the incidence of liver cancer has more than tripled. However, between 2014 and 2015, incidence rates slowed in women while remaining steady in men. Men are almost 3 times more likely than women to be diagnosed with the disease. Worldwide, an estimated 905,677 people were diagnosed with liver cancer in 2020.

It is estimated that 29,380 deaths (19,000 men and 10,380 women) from this disease will occur in the United States in 2023. For men, liver cancer is the fifth most common cause of cancer death. It is the seventh most common cause of cancer death among women. Although the overall liver cancer death rate more than doubled since 1980, it stabilized between 2016 and 2020 for both men and women.

Worldwide, liver cancer is the third leading cause of cancer death. In 2020, an estimated 830,180 people around the world died from the disease. When compared with the United States, liver cancer is much more common in sub-Saharan Africa and Southeast Asia. In some countries, it is the most common type of cancer.

What is the survival rate for liver cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from liver cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with liver cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with liver cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for liver cancer in the United States is 21%, compared to 3% 40 years ago.

The survival rates for liver cancer vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works.

For the 43% of people who are diagnosed with liver cancer at an early stage, the 5-year relative survival rate is 36%. If the cancer has spread to surrounding tissues or organs and/or to the regional lymph nodes, the 5-year relative survival rate is 13%. If the cancer has spread to a distant part of the body, the 5-year relative survival rate is 3%. However, even if the cancer is found at a more advanced stage, treatments are available to help many people with liver cancer experience a quality of life similar to that of before their diagnosis, at least for some time. If surgery is possible, it generally results in higher survival rates across all stages of the disease.

Experts measure relative survival rate statistics for liver cancer every 5 years. This means the estimate may not reflect the results of advancements in how liver cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2023, the ACS website, and the International Agency for Cancer Research website. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations. It offers a drawing of the location of the liver in the body. Use the menu to choose a different section to read in this guide.

Liver Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find a basic drawing of the location of the liver in the body. To see other pages, use the menu.

The liver is a large organ located near the bottom of the rib cage on the right side of the body, above the stomach.

Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and Prevention. It describes the factors that may increase the chance of developing liver cancer and ways to lower your risk. Use the menu to choose a different section to read in this guide. 

Liver Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find out more about the factors that increase the chance of developing liver cancer and ways to lower your risk. Use the menu to see other pages.

What are the risk factors for liver cancer?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing liver cancer. The main risks in the United States are cirrhosis of the liver and nonalcoholic fatty liver disease (NAFLD), explained below:

  • Cirrhosis. Cirrhosis develops when liver cells are damaged and replaced by scar tissue. Most cirrhosis in the United States is caused by regularly drinking too much alcohol, called alcohol abuse. Other causes are NAFLD, viral hepatitis (types B and C, as described below), too much iron in the liver from a disease called hemochromatosis, reduced blood flow to the liver from a condition called portal hypertension, and some other rare types of chronic liver disease. The combination of alcohol abuse and hepatitis virus infection puts people at high risk of cirrhosis and hepatocellular carcinoma (HCC).

  • Obesity, NAFLD, and diabetes. Obesity causes fat to be deposited in the liver, which leads to NAFLD. Over the past decade, strong evidence has emerged suggesting that NAFLD and diabetes, a related disease, are increasingly important risk factors for HCC in the United States.

  • Viral hepatitis. Hepatitis viruses are viruses that infect the liver. The 2 common types are hepatitis B and hepatitis C. Viral hepatitis is the largest risk factor for liver cancer worldwide. Hepatitis C has become much more common than hepatitis B because there is no vaccine to prevent hepatitis C.

    Viral hepatitis can be passed from person to person through exposure to blood or bodily fluids. This can happen through physical injury or trauma, by sharing needles during drug use or the tattooing process, or by sexual contact. In the case of hepatitis B, an unborn baby or infant can get the virus if the mother has it. This can be avoided by vaccinating the baby.

    If you develop acute hepatitis B or C and then “clear the virus,” you recover completely from the acute infection. Only people who do not clear the virus and have a persistent infection have an increased risk. Your doctor will be able to perform blood tests that tell if you have cleared the virus.

  • Age. In the United States, adult primary liver cancer occurs most often in people older than 60.

  • Sex. Men are more likely than women to develop liver cancer.

  • Environmental factors. Some environmental factors may increase the risk of liver cancer, such as exposure to certain chemicals or eating food contaminated with aflatoxin. Aflatoxin is a toxin made by a mold that can grow on stored nuts and grains. There is less risk of this in the United States.

Risk factors are cumulative. This means that having more than 1 risk factor increases a person's risk of developing liver cancer more. For instance, a person who carries both hepatitis B and C has a higher risk than a person carrying 1 type of the virus. Similarly, a person with hepatitis C who also drinks alcohol has a higher risk.

Are there ways to prevent liver cancer?

Different factors cause different types of cancer. Researchers continue to look into what factors cause liver cancer, including ways to prevent it. Although there is no proven way to completely prevent liver cancer, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

In the United States, HCC can usually be avoided by preventing viral hepatitis and cirrhosis. A vaccine can protect healthy people from contracting hepatitis B. In fact, the U.S. Centers for Disease Control and Prevention recommends that all children should have this vaccination. There is no vaccine against hepatitis C, which is most often associated with current or previous intravenous (IV) drug abuse. Blood banks in the United States check donated blood to make sure that blood carrying the hepatitis viruses is not used.

Cirrhosis can be avoided by not abusing alcohol and preventing viral hepatitis. Most industrialized countries have regulations to protect people from cancer-causing chemicals. In the United States, such regulations have virtually eliminated these chemicals that can cause HCC.

There is increasing evidence that certain medications can control chronic hepatitis B or C infection. This can reduce the inflammation and damage these viruses cause in the liver. There have been major advances in recent years in antiviral therapy, particularly for chronic hepatitis C virus infection. This is likely to have a major positive impact on liver cancer prevention, particularly if taken before cirrhosis develops. For information about these types of treatments, it is important to talk with a hepatologist. A hepatologist is a doctor who specializes in diseases of the liver.

Because of its link to obesity, NAFLD is becoming an increasingly important risk factor for HCC. People are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and participating in moderate physical activity. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level.

Learn more about cancer prevention and healthy living.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Liver Cancer - Screening

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find out more about screening for liver cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

  • Identify people who may need more frequent screening or a different type of screening because they have a higher risk of developing cancer due to genetic mutations, hereditary syndromes, or family history

Learn more about the basics of cancer screening.

How are people screened for liver cancer?

If you know you have cirrhosis or other risk factors, it is extremely important to talk with your doctor about whether you should be regularly screened for liver cancer. Finding a cancer before any symptoms have developed will increase the chance of successful treatment. Hepatologists are the doctors with the most experience in screening for primary liver cancer. You may also see the term “surveillance” used to explain this, but this means the same as screening.

Screening options for liver cancer include testing the blood for a substance called alpha-fetoprotein (AFP), which may be produced by cancer cells, or having imaging tests like an ultrasound, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI). More information about these tests can be found in the Diagnosis section.

Talk with a hepatologist about which screening tests they recommend and how often to have them based on your medical history. Different guidelines apply to different causes of liver disease.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems liver cancer can cause. Use the menu to choose a different section to read in this guide.

Liver Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find out more about the changes and medical problems that can be a sign of liver cancer. Use the menu to see other pages.

What are the symptoms and signs of liver cancer?

People with liver cancer may experience one or more of the following symptoms or signs. Or, they may experience no symptoms, particularly when the tumor is detected early as part of a screening program. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. When symptoms or signs of liver cancer do occur, they may include those described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer.

  • Pain, especially at the top right of the abdominal area, near the right shoulder blade, or in the back

  • Unexplained weight loss

  • A hard lump under the ribs on the right side of the body, which could be the tumor or a sign that the liver has gotten bigger

  • Weakness or fatigue

  • Yellowing of the skin or eyes, called jaundice

  • Itching of the skin, called pruritis

When hepatocellular carcinoma (HCC) is diagnosed, some people will already know that they have cirrhosis and will be receiving care from a doctor. Some symptoms experienced by people with HCC may be caused by cirrhosis rather than the tumor. These symptoms include abdominal swelling from fluid accumulation, called ascites, and needing more water tablets, called diuretics, to control the fluid accumulation. Hepatic encephalopathy (mental confusion), bleeding from the esophagus or stomach, or any worsening of the condition may also indicate cancer.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will try to understand what is causing your symptom(s). They may do an exam and order tests to understand the cause of the problem, which is called a diagnosis.

If liver cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative and supportive care," which is not the same as hospice care given at the end of life. This type of care focuses on managing symptoms and supporting people who face serious illnesses, such as cancer. You can receive palliative and supportive care at any time during cancer treatment. Learn more in this guide’s section on Coping with Treatment.

Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Liver Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible or recommended, the doctor may suggest other tests that will help make a diagnosis.

How liver cancer is diagnosed

There are different tests used for diagnosing liver cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose hepatocellular carcinoma (HCC):

  • Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check for lumps, swelling, or other changes in the liver, spleen, and other nearby organs. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, including yellowing of the skin and whites of the eyes.

  • Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called alpha-fetoprotein (AFP). In the United States, AFP is found in elevated levels in the blood of about 50% to 70% of people who have HCC. The doctor will also test the person’s blood to see if there is hepatitis B or C. Other blood tests can show how well the liver is working.

In addition, other tests are commonly needed to diagnose HCC, to find where the tumor is located in the liver, and to see if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend 1 or more of the following tests:

  • Ultrasound. An ultrasound creates a picture of the internal organs using sound waves. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional image of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Often, HCC can be diagnosed based on features specific to the cancer that are seen on a CT scan. This helps patients avoid a liver biopsy (see below). A CT scan can be used to measure the tumor’s size.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Angiogram. An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.

  • Laparoscopy. Laparoscopy is a test that shows the inside of the body using a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Sedation uses medication to make the person relaxed and sleepy. Local anesthetic is also used to numb the area. Laparoscopy is used very rarely in diagnosing liver cancer.

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    The type of biopsy performed will depend on the location of the cancer. The biopsy can be done during a laparoscopy, a fine-needle aspiration, or a core biopsy. During a fine-needle aspiration, cells are removed using a thin needle inserted into the tumor. A core biopsy uses a thicker needle. Either procedure is done by a radiologist who uses an ultrasound to direct the needle to the particular part of the liver with the tumor. The actual biopsy procedure usually lasts for less than 1 minute. It is typically not painful, and few people have complications from the procedure.

    Before the biopsy, your doctor will test your blood to make sure it clots normally. This decreases the risk of bleeding after the procedure. Sometimes, your doctor might perform a laparoscopy and biopsy to look at the non-cancerous part of the liver to find out if you have cirrhosis, which will help determine the best treatment options.

    • When the AFP blood test, CT scan, or MRI strongly indicates HCC and other test results are typical of HCC, a biopsy may not be needed. Also, most surgeons will recommend that a biopsy be done as part of surgery if all or part of the liver is being removed rather than as a separate procedure beforehand. See the Types of Treatment section for more information about surgery for liver cancer.

      It is also important to note that with newer imaging methods, very small masses are easier to find. However, it is not always possible to identify what a very small mass is and whether it is cancer. In these instances, especially when the mass is 1 centimeter or smaller in size, the doctor may recommend a “watch and wait” approach. This is also called active surveillance or watchful waiting. This means that the scans are repeated in 3 to 6 months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, the doctor will then do a biopsy.

  • Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Types of Treatment).

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is HCC, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Liver Cancer - Stages

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

READ MORE BELOW:

What is cancer staging?

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Staging a cancer helps determine the prognosis of the disease, which is the chance of recovery, and the types of treatment that are most appropriate. In general, only early-stage liver cancer can be cured.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment and may help predict a patient's prognosis. There are different stage descriptions for different types of cancer.

As explained in the Introduction, there are 2 types of liver cancer: primary and metastatic. Primary liver cancer begins in the liver. Metastatic (secondary) liver cancer is cancer that has spread to the liver after starting in another part of the body. This section describes the stages of primary liver cancer. For information about the stages of metastatic cancer, read about the type of cancer where it began. For example, lung cancer that has spread to the liver is called "metastatic lung cancer" and will be staged as lung cancer, not liver cancer.

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Barcelona Clinic Liver Cancer (BCLC) staging system

For hepatocellular carcinoma (HCC), doctors often use the BCLC staging system to describe the cancer and recommend treatment options, which are described in more detail in Types of Treatment. The BCLC staging system categorizes HCC based on characteristics of the tumor, liver function, performance status, and cancer-related symptoms.

BCLC stage groupings include:

  • Very early stage. The tumor is smaller than 2 centimeters (cm). There is no increased pressure in the portal vein, which is one of the main blood vessels of the liver. Bilirubin levels, which is the substance that causes jaundice, are normal. Surgery is usually recommended (see Types of Treatment).

  • Early stage. The tumor is smaller than 5 cm. Liver function varies. There may be no increased pressure in the portal vein, increased portal vein pressure and normal bilirubin levels, or increased portal vein pressure and increased bilirubin levels. People with early-stage disease may be candidates for a liver transplant, surgery, or radiofrequency ablation (RFA) (see Types of Treatment).

  • Intermediate stage. The tumor may be large or there may be multiple tumors. Doctors usually recommend regional therapies, such as transarterial chemoembolization (see Types of Treatment). 

  • Advanced stage. The tumor has invaded the portal vein or spread to other parts of the body, such as the lymph nodes, lungs, and bones. Doctors usually recommend targeted therapy (see Types of Treatment).

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Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Liver Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will learn about the different treatments doctors use for people with liver cancer. Use the menu to see other pages.

This section explains the treatments, also known as therapies, that are the standard of care for hepatocellular carcinoma (HCC). “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for liver cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How liver cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors:

  • How much of the liver is affected by the cancer

  • Whether the cancer has spread

  • The patient’s preferences and overall health

  • The damage to the remaining cancer-free area of the liver

When a tumor is found at an early stage and the patient’s liver is working well, treatment is aimed at trying to eliminate the cancer. The care plan may also include treatment for symptoms and side effects, an important part of cancer care. When liver cancer is found at a later stage, or the patient’s liver is not working well, the patient and doctor should talk about the goals of each treatment recommendation. At this point, the goals of treatment may focus on slowing the growth of the cancer and relieving symptoms to improve quality of life.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called "shared decision-making." Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for liver cancer because there are different treatment options. Learn more about making treatment decisions.

The various disease-directed treatment options for liver cancer can be grouped according to whether they may cure the cancer, or if they will improve survival but will most likely not eliminate the cancer. Descriptions of the most common treatment options, both disease-directed and those aimed at managing side effects and symptoms, are listed below.

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Disease-directed treatments to eliminate and potentially cure HCC

These treatments are most likely to be recommended when the tumor has been found at an early stage. They may not be recommended to treat later stages of disease. These treatments are surgery, radiofrequency ablation, percutaneous ethanol injection, and radiation therapy.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with good liver function and tumors that can be safely removed from a limited portion of the liver. Surgery may not be an option if the tumor takes up too much of the liver, the liver is too damaged, the tumor has spread outside of the liver, or if the patient has other serious illnesses.

A surgical oncologist is a doctor who specializes in treating cancer using surgery. A hepatobiliary surgeon also has specialized training in surgery on the liver and pancreas. Sometimes, liver transplant surgeons are involved in these operations. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Two types of surgery are used to treat HCC:

  • Hepatectomy. When a portion of the liver is removed, the surgery is called a hepatectomy. A hepatectomy can be done only if the cancer is in 1 part of the liver and the liver is working well. The remaining section of liver takes over the functions of the entire liver. The liver may grow back to its normal size within a few weeks. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small.

    The side effects of a hepatectomy may include pain, weakness, fatigue, and temporary liver failure. The health care team will watch for signs of bleeding, infection, liver failure, or other problems that need immediate treatment.

  • Liver transplantation. Sometimes, a liver transplantation can be done. This is a surgery in which the patient's liver is removed and replaced by healthy liver tissue from a donor. This procedure is possible only when specific criteria are met, including having a certain tumor size and number of tumors and whether a suitable donor is found. These criteria are usually either having a single tumor that is 5 cm or smaller or having 3 or fewer tumors, all of which are smaller than 3 cm. It is important to note that the number of available donor livers is very limited, so transplantation is not always an option.

    After a transplant, the patient will be watched closely for signs that the body might be rejecting the new liver or that the tumor has come back. The patient must take medication to prevent rejection. These drugs can cause side effects, such as puffiness in the face, high blood pressure, or increased body hair. Liver transplant has significant risks of serious complications, including death from infection, the body's rejection of the donor liver, and the possibility of an increased risk of other unrelated cancers.

    Liver transplantation is a particularly effective treatment for people with a small tumor because transplantation removes the tumor and the damaged liver. However, there are few donors, and people waiting for a liver transplant may have to wait for a long time before a liver becomes available. During this time, the disease may get worse. The transplant center will advise you on how long the wait is likely to be and what rules are used to prioritize people on the waiting list.

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Radiofrequency ablation (RFA)

RFA and microwave therapy both use heat to destroy cancer cells. They may be given through the skin, through laparoscopy, or during a surgical operation while a patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy. This treatment approach is also called thermal ablation.

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Percutaneous ethanol injection

Percutaneous ethanol injection is when alcohol is injected directly into the liver tumor to destroy it. Side effects include fever and pain after the procedure. In general, the procedure is simple, safe, and particularly effective for a tumor smaller than 3 centimeters (cm). However, if the alcohol escapes from the liver, a person may have brief but severe pain. This option is rarely used and has been largely replaced by RFA (see above).

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

  • Stereotactic body radiation therapy (SBRT). SBRT is a term that describes several methods of delivering high doses of radiation therapy to a tumor while limiting the amount of radiation to nearby healthy tissue. This is important because healthy liver tissue can be damaged by radiation. SBRT effectively treats tumors that are about 5 cm or smaller. However, it is still considered investigational compared to RFA (see above) because there is not much available information about its long-term effectiveness.

Side effects of SBRT may include damage to the stomach and lungs. However, these side effects can often be prevented. Talk with your health care team about avoiding and managing possible side effects. Learn more about the basics of radiation therapy.

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Disease-directed treatments to help patients live longer

If the doctor feels the cancer cannot be cured using the treatments listed above or if the cancer is at a more advanced stage, the doctor may recommend one of the following options to shrink the tumor and/or slow tumor growth. While these treatments will most likely not eliminate the cancer, they have been shown to extend how long patients can live.

Chemoembolization and radioembolization for disease confined to the liver

Chemoembolization is a type of chemotherapy treatment that is similar to hepatic arterial infusion (see below). Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. During chemoembolization, drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also destroys cancer cells.

In addition to being used as a primary treatment for HCC, chemoembolization may be used to slow tumor growth for people who are on the waiting list for liver transplantation (see "Surgery," above).

Radioembolization is similar to chemoembolization, except that during radioembolization, a doctor places radioactive beads into the artery that supplies the tumor with blood. The beads deliver radiation therapy directly into the tumor when they become trapped in the small blood vessels of the tumor.

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Systemic therapy for advanced HCC (updated 03/2024)

The treatment plan for later-stage HCC may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle, an injection into a muscle or under the skin, or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them. Your doctor will consider certain factors of your cancer and your overall health, including your liver function, when determining whether systemic therapy is recommended for you.

The types of medications used for advanced HCC include:

  • Targeted therapy

  • Immunotherapy

The first-line treatment is the initial treatment given. First-line treatment options for advanced HCC include:

  • The combination of bevacizumab (Avastin; see “Targeted therapy” below) with atezolizumab (Tecentriq; see "Immunotherapy" below) or tremelimumab (Imjudo) with durvalumab (Imfinzi; see “Immunotherapy” below for both) may be offered to some patients with advanced HCC.

  • Targeted therapy with sorafenib (Nexavar) or lenvatinib (Lenvima; see “Targeted therapy” below for both) or immunotherapy with durvalumab may be offered to people who are unable to receive atezolizumab with bevacizumab or duvalumab with tremelimumab.

A second-line treatment is given if the first-line treatment does not work. Second-line treatment options for people with advanced HCC who have already received bevacizumab with atezolizumab include:

  • Sorafenib

  • Lenvatinib

  • Cabozantinib (Cabometyx; a targeted therapy)

  • Regorafenib (Stivarga; a targeted therapy)

  • Ramucirumab (Cyramza; a targeted therapy)

  • Nivolumab (Opdivo) with ipilimumab (Yervoy), both of which are a type of drug called immune checkpoint inhibitors (see “Immunotherapy” below)

  • Tremelimumab with durvalumab

Second-line treatment options for people with advanced HCC who have already received tremelimumab with durvalumab include:

  • Sorafenib

  • Lenvatinib

  • Cabozantinib

  • Regorafenib

  • Ramucirumab

  • Bevacizumab with atezolizumab

Second-line treatment options for people with advanced HCC who have already received sorafenib or lenvatinib include:

  • Cabozantinib

  • Nivolumab (with or without ipilimumab)

  • Regorafenib

  • Ramucirumab

  • Durvalumab (with or without tremelimumab)

  • Bevacizumab with atezolizumab

  • Pembrolizumab (Keytruda; see “Immunotherapy” below)

If the second-line treatment does not work, the doctor may recommend third-line treatment using a different one of the treatment options above.

This information is based on the ASCO guideline, “Systemic Therapy for Advanced Hepatocellular Carcinoma.” Please note that this link takes you to another ASCO website.

type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. The medications used to treat cancer are continually being evaluated. Your doctor may suggest clinical trials that are studying new ways to treat HCC.

Talking with your doctor is often the best way to learn about the medications that can be prescribed for you, their purpose, and their potential side effects. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

For HCC, anti-angiogenesis drugs are the most common type of targeted therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Some anti-angiogenesis therapies are for people with unresectable HCC. Unresectable means that surgery is not an option.

Anti-angiogenesis therapies include:

  • Bevacizumab with atezolizumab. In 2020, the U.S. Food and Drug Administration (FDA) approved the combination of the anti-angiogenesis targeted therapy, bevacizumab, with atezolizumab, an immunotherapy drug (see "Immunotherapy" below), for people with unresectable or metastatic HCC who have not received previous cancer treatment using medications. Unlike many anti-angiogenesis therapies, which are taken as pills, bevacizumab is given intravenously.

  • Lenvatinib. In 2018, the FDA approved an anti-angiogenesis targeted therapy called lenvatinib. This drug is approved as a first treatment for HCC that cannot be removed by surgery. It is taken as a pill that is swallowed (orally).

  • Sorafenib. Sorafenib is used to treat advanced HCC that cannot be completely removed with surgery. It is taken as a pill that is swallowed (orally).

  • Ramucirumab. Ramucirumab is another anti-angiogenesis therapy approved for treating HCC that has high levels of the tumor marker alpha-fetoprotein (AFP) for patients who have already received sorafenib. It is given intravenously.

  • Cabozantinib. In 2019, the FDA approved the use of cabozantinib to treat HCC for people who have previously received sorafenib. It is taken as a pill that is swallowed (orally).

  • Regorafenib. In 2017, the FDA approved the use of another targeted therapy, regorafenib, to treat people with HCC that was previously treated with sorafenib. Regorafenib also inhibits angiogenesis. It is taken as a pill that is swallowed (orally).

Side effects of targeted therapy can vary but may include high blood pressure, back pain, headaches, changes in taste, fatigue, diarrhea, appetite loss, joint and muscle pain, weight loss, abdominal pain, rash, redness, itching or peeling of the skin on the hands and feet, hoarseness, bleeding, change in thyroid hormone levels, and nausea. Talk with your doctor about the possible side effects for a specific medication and how they can be managed.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. One common type of immunotherapy is called an immune checkpoint inhibitor. Immune checkpoint inhibitors work by blocking the pathways that would otherwise allow the cancer to hide from the immune system.

Immunotherapies for HCC include:

  • Nivolumab. In 2017, the FDA approved an immunotherapy called nivolumab for the treatment of HCC. Nivolumab can be used to treat people who have already been treated with sorafenib, which is a type of targeted therapy.

  • Pembrolizumab. In 2018, the FDA approved the immunotherapy pembrolizumab for the treatment of people with HCC. Like nivolumab, pembrolizumab can be used to treat people who have previously been treated with sorafenib. Pembrolizumab is an immune checkpoint inhibitor.

  • Nivolumab with ipilimumab (Yervoy). In 2020, the FDA approved the use of the combination of nivolumab with another immunotherapy drug called ipilimumab (Yervoy) to treat patients with HCC who have already been treated with sorafenib. Both nivolumab and ipilimumab are a type of immunotherapy called immune checkpoint inhibitors, which means they work to block the pathways that would otherwise allow the cancer to hide from the immune system. Both nivolumab and ipilimumab are immune checkpoint inhibitors.

  • Atezolizumab with bevacizumab. In 2020, the FDA approved the use of the combination of atezolizumab, an immunotherapy drug, with bevacizumab, a targeted therapy drug, for people with unresectable or metastatic HCC who have not received previous cancer treatment using medications. Atezolizumab is an immune checkpoint inhibitor, and bevacizumab is an anti-angiogenesis therapy (see "Targeted therapy" above).

  • Tremelimumab and durvalumab. In 2022, the FDA approved the combination of 2 immunotherapy drugs, tremelimumab and durvalumab, for the treatment of people with HCC that cannot be removed with surgery. Both tremelimumab and durvalumab are immune checkpoint inhibitors.

Other immunotherapy drugs, including durvalumab (Imfinzi) and tremelimumab, are still being studied in clinical trials but have shown promise in treating HCC. Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your health care team about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Clinical trials

In addition to the treatment options described above, your doctor may suggest participating in a clinical trial that is evaluating a new treatment approach for HCC. This is particularly important for a disease like advanced HCC, where options for treating the disease are very limited and there is ongoing research to find more treatment options. Learn more about the Latest Research areas in HCC.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as surgery or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic HCC

If HCC has spread to another location in the body, it is called metastatic cancer. People with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment so you are comfortable with your chosen treatment plan and cancer care team. This discussion may include clinical trials studying new treatments.

Your treatment plan may include a combination of surgery, targeted therapy, radiation therapy, and/or other options. At this stage, the goal of treatment is typically to slow the cancer’s growth. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent liver cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief, fear, or disappointment that the first treatment did not entirely eliminate the cancer. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Liver Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with liver cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of liver cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments.

The number of clinical trials focused on hepatocellular carcinoma (HCC) has increased in recent years. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating HCC. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with HCC.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for HCC, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials.

There are many resources and services to help you search for clinical trials for HCC, including the following services. Please note that these links will take you to separate, independent websites:

  • ClinicalTrials.gov. This U.S. government database lists publicly and privately supported clinical trials.

  • World Health Organization (WHO) International Clinical Trials Registry Platform. The WHO coordinates health matters within the United Nations. This search portal gathers clinical trial information from many countries’ registries.

Read more about the basics of clinical trials matching services.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials located in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for liver cancer. Use the menu to choose a different section to read in this guide.

Liver Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will read about the scientific research being done to learn more about liver cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about liver cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with liver cancer. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Cancer vaccines. Cancer vaccines are treatments that may help the immune system recognize and attack hepatocellular carcinoma (HCC) cells. Sometimes the vaccine is given with an immune system stimulant, such as sargramostim (Leukine, Prokine).

  • Combining systemic cancer medications. Different drugs destroy cancer cells in different ways. Using a combination of drugs can increase the chance that more cancer cells will be destroyed. Many times, 1 drug will help another drug work better.

  • Combining other therapies. Researchers are looking into whether combining treatments, such as radiofrequency ablation (RFA) and chemoembolization, is more effective than using these treatments separately.

  • Anti-angiogenesis drugs. In addition to sorafenib and regorafenib, which are discussed in Types of Treatment, several other anti-angiogenic drugs are being studied in clinical trials.

  • Greater use of liver transplantation. Researchers are investigating the possibility of expanding the criteria for liver transplantation for HCC. This would make more patients eligible for the procedure.

  • Gene therapy. This new treatment changes a gene to fight cancer. Although gene therapy is in the very early stages of development, some clinical trials are already underway. In one example, the new gene makes chemotherapy work better. In this type of treatment, a gene can be directly injected into the tumor. The doctor then gives the patient an inactive drug, and the new gene helps activate the drug in the tumor. This approach is also being tested in combination with the other treatments listed above.

  • Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current HCC treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in liver cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Liver Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

READ MORE BELOW:

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative and supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for hepatocellular carcinoma (HCC) are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-Up Care section of this guide or talking with your doctor.

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Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, fear, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

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Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations, in a separate part of this website.

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Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, adults older than 65, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

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Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should I call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

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Caring for a loved one with liver cancer

Family members and friends often play an important role in taking care of a person with HCC. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

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Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

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The next section in this guide is Follow-Up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

Liver Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Research to find ways to prevent second cancers and recurrent hepatocellular carcinoma (HCC) is ongoing, but there is no standard prevention method at this time.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Liver Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, the term “survivorship” itself does not feel right, and they may prefer to use different language to describe and define their experience. Sometimes long-term treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from hepatocellular carcinoma (HCC) are encouraged to follow established guidelines for good health, such as not smoking, limiting or avoiding alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-Up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Liver Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type and subtype of liver cancer do I have?

  • How large is the tumor?

  • What is the stage of my cancer? What does this mean?

  • Can the tumor be removed surgically? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about risk factors

  • Do I have cirrhosis of the liver? What does this mean?

  • Do I have nonalcoholic fatty liver disease (NAFLD)? What does this mean?

  • Am I a carrier of hepatitis B or C? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What types of research are being done for liver cancer in clinical trials? Do clinical trials offer additional treatment options for me?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the chances for success with the planned treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Do I need to start treatment right away?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • How much of my liver will be removed?

  • Will I need a liver transplant?

  • If I need a liver transplant, am I likely to be prioritized on the transplant waiting list? How long should I expect to wait?

  • How long will the operation take?

  • Will I need to stay in the hospital for this surgery? If so, for how long?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible side effects of my surgery, in the short term and the long term?

Questions to ask about chemotherapy, targeted therapy, and immunotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How will it be delivered (through an intravenous (IV) tube, a catheter, or a pill)?

  • What does the preparation for this treatment involve?

  • How long will it take to give this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve these side effects?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve these side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • When should I return to my primary care doctor for regular medical care?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Liver Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Liver Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Liver Cancer. Use the menu to choose a different section to read in this guide.