Surgery for liver cancer
Surgery is sometimes used to treat stage 0 or A liver cancer. Unfortunately, surgery is not always an option because liver cancer is often diagnosed at a more advanced stage.
Before the healthcare team offers surgery for liver cancer, they will make sure you are healthy enough to have and recover from surgery. They base this on your Child-Pugh score, which grades the level of damage or failure caused by scarring of the liver (called cirrhosis). The Child-Pugh score is an important part of prognosis for liver cancer.
When deciding whether or not to offer surgery and the type of surgery to do, the healthcare team will also consider the stage of the cancer. They will look at diagnostic tests to see if the cancer can be completely removed with surgery. This is possible if it hasn’t spread to lymph nodes, blood vessels or other organs. In general, the type of surgery offered depends mainly on the size and number of tumours, as well as the amount of cirrhosis in the liver. Find out more about staging liver cancer.
The following types of surgery are used to treat liver cancer. You may also have other treatments before or after surgery.
A liver resection may also be called a partial hepatectomy. It is surgery to remove the tumour along with some healthy liver tissue around the tumour (called the surgical margin). It is only done if tests show that the liver left after surgery will be healthy enough to work normally.
A liver resection is the main treatment when there is no cirrhosis of the liver and:
- there is only 1 tumour that is less than 2 cm in size
- the tumour hasn’t grown into blood vessels in the liver
- the cancer hasn’t spread to the lymph nodes
A liver resection may be offered to people who have cirrhosis if:
- the Child-Pugh score is A
- the BCLC stage is either stage 0 or stage A1
A liver resection may also be offered if there are 3 tumours that are very close to one another so that they can be removed together and liver function is normal.
During a liver transplant, the surgeon removes the diseased liver and replaces it with a healthy liver from an organ donor. It is the main treatment for people who have severe cirrhosis of the liver and the rest of the liver would not work normally after surgery to remove a tumour. This includes liver cancer that is BCLC stage 0, A1, A2, A3 or A4. People with Child-Pugh scores B or C may also be considered for a transplant.
To be eligible to have a liver transplant, you have to be healthy enough for surgery and the liver cancer must meet certain criteria. If you are on a transplant list, your healthcare team may offer radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). These treatments help keep the tumour small enough to meet the transplant eligibility criteria (called “bridging” therapy) while waiting for an available donor liver.
Liver transplant is only done in hospitals with a transplant program. The transplant team provides information and support throughout the process. They will do tests to find out if a person is a good candidate for a liver transplant. To be eligible:
- the cancer must not have spread outside the liver
- the cancer must not be in the major blood vessels of the liver
- there is only 1 tumour that is smaller than 5 cm, or there are up to 3 tumours but none of them is larger than 3 cm
Types of liver donations
In Canada, only a small number of people with liver cancer will have liver transplant surgery. This is because the healthy liver used in a transplant most often comes from someone who has died and donated their organs. Only a small number of donated livers are available, so there is often a waiting period until a liver becomes available. Unfortunately, the wait for an organ donor may be too long for some people with liver cancer. Their cancer may continue to grow, and they may no longer be healthy enough to have surgery. Some people die from liver cancer before a donor liver becomes available.
Another option may be a living donor transplant. An adult donor gives part of their liver (usually the right lobe) to the person with cancer. Living donor transplant is possible because the liver can regrow, or regenerate, itself after surgery. Living donor transplant may mean that the donation is available while the person with liver cancer is still healthy enough to have the surgery and before the cancer spreads outside the liver. As with any surgery, the donor may have side effects and must consider the risks. The transplant team will discuss these risks with people who are offering to donate part of their liver. In Canada, living donor transplant is only done by transplant programs with experience in this type of transplant.
After liver transplant
If you have any type of liver transplant, you will need to take immunosuppressive medicines. These drugs stop your body from rejecting the donated liver.
Side effects can happen with any type of treatment for liver cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects will depend mainly on the type of surgery, where the tumour was found in the liver and your overall health. People with cirrhosis are more likely to have side effects after surgery, and those side effects are usually more severe than in people without cirrhosis.
Surgery for liver cancer may cause these side effects:
- tissue scarring that increases the blood pressure in the portal vein (called portal hypertension)
- swollen veins in the stomach or esophagus (called varices)
- abnormal liver function
- liver failure
- rejection of the donated liver used in a transplant
Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Questions to ask about surgery
Suppression of the body’s immune system so it is less able to fight infections or diseases.
Immunosuppression can be caused by certain diseases, such as AIDS or lymphoma. It may also be a side effect of certain chemotherapy drugs. Doctors may also deliberately suppress the immune system before organ or stem cell transplants to prevent rejection.
Also called immunocompromised.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.