Treatments for recurrent liver cancer

Recurrent liver cancer means that the cancer has come back after it has been treated. The following are treatment options for recurrent liver cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment options will depend on:

• where the cancer has come back
• how well your liver is working
• your overall health

You may be offered surgery if cancer comes back only in the liver.

A liver resection (partial hepatectomy) is used to remove the tumour along with an area of healthy tissue around it (called the surgical margin). It may be offered if you have enough liver tissue after the treatments you had for the original tumour, your liver is working well, the tumour can be completely removed by surgery and you do not have scarring of the liver (cirrhosis).

A liver transplant may be offered if there will not be enough liver to work well after a liver resection.

You may be offered radiofrequency ablation (RFA), microwave ablation (MWA) or percutaneous ethanol injection (PEI) if the cancer comes back in the liver and you can't have surgery.

RFA uses a high-frequency electrical current to create heat to destroy cancer cells.

MWA uses electromagnetic waves to create heat and destroy cancer cells.

PEI is a treatment that injects concentrated ethanol alcohol through a needle into a liver tumour. It is not used very often.

Transarterial chemoembolization (TACE) is a treatment that blocks the blood supply to a liver tumour and delivers chemotherapy directly to the tumour. You may be offered TACE if the recurrent liver cancer has come back in the liver only.

You may be offered transarterial radioembolization (TARE) or stereotactic body radiation therapy (SBRT) to treat recurrent liver cancer tumours.

TARE is similar to TACE, but it uses radiation to directly treat the tumour. Unlike TACE, TARE can be used if you have a blood clot in the portal vein (called portal vein thrombosis).

SBRT uses high dose external beam radiation that delivers very focused beams of high-dose radiation to liver tumours. SBRT is used to destroy liver cancer cells and control their growth. It may also be used to relieve pain caused by advanced liver cancer (called palliative treatment), such as when cancer spreads to the bones.

Targeted therapy is the standard treatment for recurrent liver cancer. It uses drugs to treat specific molecules (such as proteins) on cancer cells or inside them. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. The targeted therapy drugs used for recurrent liver cancer are sorafenib (Nexavar) and lenvatinib (Lenvima).

You may be offered targeted therapy if the cancer comes back outside of the liver or if you can't have surgery, ablation therapy, TACE or TARE.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with liver cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.