Removing the Cancer
Undergo a CT scan or MRI to find out your treatment options. The best way to treat liver cancer is to remove it, but your liver needs to be otherwise healthy for surgery to be safe. To evaluate your liver health and the extent of the cancer, your doctor will do imaging tests, such as a CT scan or MRI. This can show how many tumors you have in your liver, how large they are, and determine if the cancer has metastasized or spread. The CT scan or MRI will not hurt, but you may feel some discomfort because you need to remain still during the test. After your imaging tests, your doctor will tell you about your treatment options, which may include surgery or localized treatments that target the cancer.
Do liver function blood tests to make sure your liver is healthy. Liver function blood tests measure enzymes and proteins in your blood to see if your liver is working well. Your doctor can do this simple test in their office. You’ll just need to let them draw a blood sample, which should be painless. Then, the doctor will send the sample off to the lab for testing. If your liver is functioning well, your doctor may be able to remove your cancer. If it isn't, your doctor will recommend other treatment options.
Ask your doctor if your tumor is small enough to be removed. Since your liver is a large organ that can repair itself, it’s possible for your doctor to cut away the damaged tissue. If your tumor is small and your liver is working well, your doctor can surgically remove the tumor and some of the healthy tissue around it. In most cases, this can cure your liver cancer. Note that large tumors that also affect nearby blood vessels have a higher risk of spreading after surgery. You may not be able to get your tumor removed if it’s in a part of your liver that isn’t easily accessed, such as in the middle.Tip: Many people who experience liver cancer also have cirrhosis of the liver, making their liver too unhealthy for surgical removal. However, a transplant may be an option.
Consider a liver transplant if you’re in the early stages of primary liver cancer. Your medical team may be able to remove your cancerous liver and transplant a healthy liver. This may cure your liver cancer, as long as it hasn’t spread to any other parts of your body. Your doctor can determine if this is an option for you. You’ll only be able to receive a liver transplant if you meet the Milan criteria, meaning you are in the early stages of liver cancer and have a single tumor smaller than or equal to 5 cm (2.0 in) in diameter or up to 3 lesions smaller than 3 cm (1.2 in). Additionally, you won't be eligible for a transplant if the cancer has invaded your vascular system or has spread (metastasized) to other parts of your body. In some cases, a liver transplant may be the best option if you have primary liver cancer but your liver is too unhealthy for the doctor to surgically remove just the tumors. While you wait for a transplant, talk to your doctor about other treatment options such as embolization and/or ablation to control the cancer.
Choose a surgeon who is experienced in treating liver cancer. Your surgery will be more successful if your surgeon has specialized skills in removing liver tumors or doing transplants, depending on which surgery you need. A partial hepatectomy, or a liver resection, to remove cancerous cells can be dangerous because there's so much blood flow through the liver. Similarly, getting a transplant requires a surgeon with specialized knowledge. It's best to visit a cancer treatment center that has surgeons who specialize in performing these types of surgery. Ask your primary doctor for a referral to a surgeon who works at a cancer treatment center. Possible side effects of a partial hepatectomy include excessive bleeding, problems with blood clotting, infections, and complications from anesthesia. Potential complications from a liver transplant include transplant rejection, transplant failure, bile duct complications, bleeding, blood clots, infection, and mental confusion.
Follow your doctor's instructions to prepare for surgery. Your doctor will likely have you come in for a check up in the weeks prior to your surgery to make sure you're healthy enough for the surgery. Additionally, they may adjust the medications you take in the days or weeks leading up to surgery, such as temporarily stopping blood thinners. On the night before your surgery, stop eating before midnight. Then, make sure you take any preparation medications your doctor provided. Your doctor may have provided you with an anti-bacterial rinse that you can shower with to limit surgical infections. After you shower, don't put on any deodorant, lotions, or perfumes. Don't take any supplements or medications, including OTC medicines, without your doctor's approval. Similarly, you may need to make lifestyle changes prior to surgery, like not smoking or drinking. For best results, eat a nutritious diet and get light exercise in the weeks before your surgery, as directed by your doctor.
Expect to stay in the hospital for 5-7 days for recovery. Although you may experience pain after your surgery, your doctor will provide you with pain medication, usually through your IV, at first. Once you're able to eat, your medical team will provide you with pain medication that you can take orally, as needed. However, for the first few days, you'll be on a liquid diet. You should be able to get up and move around the day after your surgery, though you may need assistance. It's best to move around as soon as you can, as this can help prevent clots and other complications. You will continue to recover at home once you're released from the hospital. Your doctor will send you home with a prescription for pain medicine that you can take if you need it.
Using Localized Treatments
Get radiofrequency ablation to destroy the cancer cells. During this minimally invasive procedure, your doctor will use a CT scan or ultrasound to guide very thin needles into the cancer cells. Once the needles are in place, your doctor will send an electric current through the cells to heat and destroy them. Then, they’ll remove the needles. This procedure can cause discomfort, but it shouldn’t be painful.
Undergo cryoablation to freeze and kill the cancer cells. This is a simple procedure that shouldn't be painful. During cryoablation, your doctor will use an ultrasound to guide a medical instrument called a cryoprobe, which they will position near the cancer cells. Using the cryoprobe, the doctor will inject the cancer with liquid nitrogen, which freezes and destroys the cancer cells. This option is most appropriate if you have peripheral lesions. The ultrasound will show whether the treatment is working. This procedure may cause some discomfort.
Talk to your doctor about getting an alcohol injection to kill the cancer cells. This is also a minimally invasive procedure that shouldn't feel painful. Your doctor can give you the injection either through your skin or during an operation, depending on what’s best for you. Your doctor can use a long, thin needle to inject pure alcohol into the cancerous cells. The alcohol will dry out the cancer cells, which causes them to die. If you have small tumors that can't be surgically removed, this might be the best option for you. You may need to get more than one injection in order for the treatment to be effective. This procedure can cause some discomfort.
Consider chemotherapy treatments to kill the cancer cells. Although chemotherapy may sound scary, your medical team will support you throughout your treatments to help minimize their effect on you. Chemotherapy can usually be taken by mouth or intravenously. For liver cancer, it’s often injected directly into the liver via the hepatic artery. Then, the chemo drugs attack and kill the cancerous cells. You will most likely need multiple chemotherapy treatments over the course of a treatment period. Chemotherapy commonly causes both discomfort and side effects, which include hair loss, mouth sores, nausea, vomiting, diarrhea, decreased appetite, bruising, and fatigue.
Ask about chemoembolization to treat the cancer and cut off its blood supply. This treatment is actually a combination of 2 treatments, making it really effective. In addition to giving you chemotherapy treatments, your doctor will cut off the blood supply to the cancer, which will starve it. They'll do this by giving you a simple injection near the tumor, which shouldn't hurt. Over time, the tumor will shrink and die. Chemoembolization is often used to treat large or difficult to remove tumors. You may feel some discomfort during this treatment.Tip: Your doctor will block blood flow by injecting tiny plastic pellets near the tumor, which will clog the vein.
Consider radiation treatment or the insertion of radiation beads near the tumor. Radiation therapy is simple and minimally invasive. For traditional radiation therapy, your doctor will have you lie on a table. Then, they’ll direct the radiation energy beams toward your liver to treat the cancer. As another option, they may inject radiation beads directly into your liver. The radiation beads will release radiation into the cancerous cells. Although radiation doesn’t kill cancer, it can shrink the tumor and provide pain relief. Since radiation therapy can destroy healthy tissue in addition to cancerous tissue, your doctor may use it sparingly. Your doctor can help you decide if radiation is right for you, as well as which radiation treatment will work best.
Take oral medications to slow the progression of the cancer. Medications are a simple, painless way to treat your condition. Some medications can slow the growth and spread of cancer, which can give you more healthy days. This can be an option for you if you're older or don't want to undergo other treatment options. Similarly, these medications may be your best option if you have advanced liver cancer that won't respond well to other treatments. For example, the medication sorafenib (Nexavar) can slow the progression of advanced liver cancer that won’t respond to other treatments.
Try immunotherapy to boost your body's immune response to cancerous cells. Your doctor may decide the best approach is to prescribe medications that enhance your immune system response. These medications target checkpoints that are normally used to prevent the body from attacking itself. Potential adverse effects include infusion reactions (fever, chills, rash, and trouble breathing) as well as autoimmune reactions.
Coping with Liver Cancer
Talk to your doctor about treatments for pain. You may experience uncomfortable symptoms while treating your liver cancer, but your doctor can prescribe medications to support you during recovery. These might include painkillers and medications to target specific side effects, such as anti-nausea meds. You can usually take these medications as needed. Some medications may not be right for everyone, so follow your doctor’s instructions.
Consider using alternative treatments to reduce your symptoms. You can use alternative medicine to support your recovery while you undergo other cancer treatments. In some cases, alternative treatments can relieve symptoms or side effects you might experience, mainly pain and nausea. Here are some alternative treatments that may help: Deep breathing to reduce pain and anxiety about treatment. Massage can help relieve pain or discomfort. Acupuncture may relieve pain and nausea. Acupressure may provide pain relief and nausea relief.
Build yourself a support system or join a support group. Dealing with cancer is difficult, but there are people who care about you. Ask your family or friends to be there for you in this difficult time, and consider joining a support group for people who are going through a similar situation. When you need to vent or want encouragement, your support system will be there. Ask your doctor about support groups that meet in your area, or search for one online.Tip: Online forums and live chats can also be a great source of support. For instance, the American Cancer Society offers both online chats and a cancer helpline.
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