Treatment for Liver Cancer 

WashU Medicine physicians and surgeons at Siteman Cancer Center have cared for thousands of patients with liver cancer patients. They’ll design a treatment plan just for you.  

Your treatment plan will include the newest, evidence-based approaches for your cancer. Your doctors will also tailor it to your age, your lifestyle, and your goals. 

Many patients with liver cancer have surgery. Your care team might choose additional treatments, including ablation therapies and drug therapies, depending on the type and stage of your cancer.  

Surgery for Liver Cancer 

Surgeons use different procedures to treat liver cancer. Some patients will only need to have a portion of their liver taken out. Other patients will need a full liver transplant.  

If your tumor is too large or has spread too far in the liver, surgery might not be a good option right away. WashU Medicine physicians at Siteman use special techniques to prepare patients for surgery. 

Patients who come to Siteman benefit from new, advanced approaches. Whenever possible, our surgeons use robotic tools and make smaller incisions instead of a single large one. This is called “minimally-invasive surgery.” Patients who have minimally-invasive surgeries tend to recover more quickly.    

Surgeries for liver cancer at Siteman include:

• Removing part of the liver: This procedure is also called a “partial hepatectomy.” Your surgeons will take out the tumor and the liver tissue surrounding it. Depending on how many tumors you have and how far they spread, the surgeons might do the procedure in two stages. They will treat the tumors on one side of the liver, and then on the other. This is called a “staged partial hepatectomy.” It’s possible to remove up to 75% of the liver and maintain liver function. After the procedure, your liver will re-grow to its original size.
• Liver transplant: A liver transplant is a procedure to replace the liver with a healthy liver from a donor. Your doctors will evaluate you carefully to see if a transplant would be a good option for you.  

Portal Vein Embolization 

Portal vein embolization is a surgical procedure that prepares patients for a partial liver removal (hepatectomy). During a portal vein embolization, your team will block the blood flow to the area of the tumor where the tumor is. This allows the rest of your liver to grow while the tumor and the surrounding tissue does not. 
 

Within four weeks, you will have enough healthy liver tissue to have surgery safely.  

Ablation and Embolization Therapies for Liver Cancer  

Ablation therapies are procedures that treat liver tumors without surgery. Instead, they use radiation, heat, powerful drugs, and advanced imaging to target tumors while protecting healthy liver tissue.  

WashU Medicine physicians called “interventional radiologists” perform ablation and embolization therapies.  

You’ll have an ablation or embolization procedure in an operating room while you’re asleep. The interventional radiologist will make a small cut (incision) in your skin and place tools through the cut. 

Treatments include: 

• Chemoembolization: In this procedure, your doctor will deliver chemotherapy directly to the tumor, along with a medicine that blocks blood vessels. Your tumor and blood vessels feeding it will receive a strong dose of medication. The medication stops the vessels from working. This will slow down the tumor’s growth. Sometimes, chemoembolization can even shrink tumors. 
• Radioembolization: Radioembolization uses a carefully-controlled dose of radiation to block the tumor’s blood supply and stop it from growing. During this procedure, your doctor will place tiny beads containing a type of radiation called yttrium-90 (Y-90) into the blood vessels feeding the tumor. This will kill the tumor cells while also starving the tumor. The radiation will not affect the healthy liver tissue.  
• Radiofrequency ablation: During radiofrequency ablation, your doctor will place needles into the tumor. Then, they will use high-energy radiowaves to heat the needles and the tumor, killing cancer cells. 
• Microwave therapy: Like radiofrequency ablation, microwave therapy uses heat to kill tumor cells. 
• Electroporation therapy: Electroporation therapy is a new approach only available in clinical trials. Your doctor will place an electrode in the tumor and use pulses of energy to attack the tumor cells. 
  

What is drug therapy for liver cancer? 

Drug therapies are medications that fight cancer cells. Patients with liver cancer might have drug therapy to shrink a tumor before surgery. Drug therapy can also kill any cancer cells left behind after surgery. This helps prevent the cancer from coming back. 

Drug therapy can also treat liver cancers that have started to spread around the body. When this happens, the cancer has metastasized.  

Liver cancer patients typically receive a type of drug therapy called chemotherapy. Chemotherapies are medications that kill cancer cells wherever they are found in the body. Patients often get chemotherapy through an IV. 

HAI pump therapy 

HAI (Hepatic Arterial Infusion) pump therapy is an advanced approach that delivers chemotherapy directly to the liver. Because the chemotherapy is placed at the tumor site, the rest of the body is not exposed to the medication. Patients benefit from a powerful, effective treatment with more limited side effects.  

An HAI pump is about the size of the hockey puck. During a surgical procedure, your doctors will place the pump in your body. They will connect the pump to the main artery that feeds the liver (the hepatic artery). The pump releases regular doses of chemotherapy into the liver.   

HAI pump therapy helps patients with more advanced liver cancers. It can slow the progression of liver cancer. In some cases, HAI therapy can shrink tumors enough so that that they can be removed with surgery. 

At Siteman, our team is experienced at performing this complex treatment for our patients.  

When do patients with liver cancer receive radiation therapy?  

Radiation therapy uses radiation to kill cancer cells. The radiation is often in the form of a beam of energy. 

Patients with later stages of liver cancer may have radiation therapy. These are patients that have cancer that has spread throughout the liver or to other parts of the body.  

Radiation therapies used to treat liver cancer include:  

• Stereotactic body radiation therapy (SBRT): SBRT uses special equipment to target tumors precisely. It helps prevent damage to normal tissue. Your radiation oncologists can adapt your treatment plan daily using MR/CT imaging.  
• Image-guided radiation therapy: Siteman Cancer Center is a leader in using MRI technology to plan and guide radiation therapy. In some cases, radiation oncologists may use CT scans as well. 
• Proton beam therapy: Proton beam therapy targets with a narrow beam of energy particles called protons. The beam can be adjusted to stop at a specific depth. This reduces damage to tissues surrounding the tumor. Siteman was the first institution in the region to offer proton beam technology.