Primary liver cancer , cancer that begins in the liver, isn’t as common in the Western world as it is in Asian countries, although it does occur. In the United States, most cancer in the liver is secondary (metastatic) cancer which began in another organ, such as breast or lung cancer.

Treatments for the two are different. Steven Sorscher, MD, an assistant professor of medicine in the division of oncology, section of medical oncology at Washington University School of Medicine, explains that people whose cancer has spread don’t have liver cancer. “That would be referred to as ‘metastatic breast cancer to the liver’ or ‘metastatic colorectal cancer to the liver,'” says Dr. Sorscher.

Liver Cancer Treatment: Metastatic vs. Primary Liver Cancer
Metastatic cancer in the liver is generally treated as the original cancer would be, using the same chemotherapy regimens, with the hope that chemotherapy would be able to shrink it.

There are a few ways that an oncologist can approach treating primary liver cancer, including resection (surgery to remove the cancerous parts of the liver), chemotherapy, radiation , tumor ablation or embolization, and even liver transplantation.

Liver Cancer Treatment

• Surgery. In primary liver cancer, otherwise known as hepatocellular liver cancer, surgery is the only known cure, says Sorscher. If it’s possible to resect the cancerous part of the liver “without taking the entire liver, that is the usual approach, the gold standard. That would mean that the amount of liver left is enough to sustain the patient.” Of course, the cancer needs to be caught early enough, and the patient needs to be strong enough to undergo the surgery and rehabilitation after.
• Tumor ablation. Ablation means to destroy the tumor without performing surgery, and although it’s not a cure, it can help patients live longer. This may be done if surgery isn’t an option. It’s a local or targeted treatment, which means that the treatment doesn’t go throughout the entire body. Catheters are threaded into the liver so medications or radiation can be delivered directly to the cancerous areas.
• Chemotherapy. This isn’t a common choice with primary liver cancer, as it’s not been proven to be very effective when given through medications taken in pill form or intravenously (systemically through an arm or chest vein). But a technique called chemoembolization is a targeted form of chemotherapy, where the medication is delivered directly to the artery serving the liver and the artery is then sealed off.
• Radiation. Like chemotherapy, radiotherapy given externally isn’t effective for liver cancer. However, using it in a targeted therapy directly to the liver, called radioembolization, doctors have had success in lengthening patients’ life spans if they respond to the treatment.
• Transplantation. Liver transplantation is possible for a select group of patients with primary liver cancer. The cancer must be small and contained (not spread to other parts of the body). While at one time the pool of candidates for liver transplantations was very small, now more patients with larger tumors may qualify if they respond to chemoembolization or radioembolization first. These treatments may shrink the cancer enough that they may be able to have a liver transplantation. Sorscher warns, though, that the waiting list for livers is long.
• sorafenib . This is a relatively new drug in the liver cancer fight, although it was approved a bit earlier for certain kidney cancers. The brand name is Nexavar. Sorscher explains that it’s a medication given in the advanced stages of liver cancer. In a study done about three years ago, “[among] those who received sorafenib, the average person lived about three months longer than those who didn’t get sorafenib,” says Sorscher.