• A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done.
  • • A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed.
    • The remaining liver tissue takes over the functions of the liver and may re-grow.
• Total Hepatectomy with Liver transplant: In a liver transplant, the entire liver is removed and replaced with a healthy donated liver.
  • A liver transplant may be done when the disease is in the liver only and a donated liver can be found.
  • If the patient has to wait for a donated liver, other treatment is given as needed.

Possible side effect is rejection of the liver.

• Other side effects may be specific to drugs given.
• Immediately call your doctor if you experience a fever, redness or pus at your surgery site, bleeding or signs of liver failure – yellowing of the skin or whites of the eyes, dark urine or confusion – after surgery.

Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:

• Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor.
  • High-energy radio waves heat the needles and tumor which kills cancer cells.
• Microwave therapy: A type of treatment in which the tumor is exposed to high temperatures created by microwaves.
  • This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
• Percutaneous ethanol injection: A cancer treatment in which a small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells.
  • Several treatments may be needed.
  • Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be used.
• Cryoablation: A treatment that uses an instrument to freeze and destroy cancer cells.
  • This type of treatment is also called cryotherapy and cryosurgery.
  • The doctor may use ultrasound to guide the instrument.
• Electroporation therapy: A treatment that sends electrical pulses through an electrode placed in a tumor to kill cancer cells.
  • Electroporation therapy is being studied in clinical trials.

The use of substances to block or decrease the flow of blood through the hepatic artery to the tumor.

• When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow.
• Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver.
• The liver receives blood from the hepatic portal vein and the hepatic artery.
  • Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue.
  • Blood that comes from the hepatic artery usually goes to the tumor.
• When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.
  
  There are two main types of embolization therapy:
• Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery.
  • Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
• Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given.
  • The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery.
  • Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body.
  • This type of treatment is also called chemoembolization.

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.

• Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
• Tyrosine kinase inhibitors are a type of targeted therapy used in the treatment of adult primary liver cancer.
  
  • Tyrosine kinase inhibitors are small-molecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide.
  • Some tyrosine kinase inhibitors also have angiogenesis inhibitor effects.
  • Sorafenib, lenvatinib, regorafenib, and cabozantinib are types of tyrosine kinase inhibitors used to treat advanced liver cancer.

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer.

• Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.
• This cancer treatment is a type of biologic therapy.
• Immune checkpoint inhibitor therapy is a type of immunotherapy.
• PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check.
  • PD-L1 is a protein found on some types of cancer cells.
  • When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.
  • This allows the T cells to kill cancer cells.
  • Pembrolizumab is a type of PD-1 inhibitor.

Radiation therapy
Targeted therapy