5 Essential Tips for Liver Cancer Treatment Decisions

Liver cancer, like many cancers, can be complex and multifaceted. After being diagnosed, you’ll face several important decisions, especially when it comes to choosing the most effective treatment options. It may feel overwhelming to select a treatment plan that aligns with your specific medical situation. However, with the right guidance and understanding of your options, you can make an informed decision that best suits you.

When determining the most appropriate treatment for liver cancer, the stage of the cancer is not the only factor your doctor will consider—your liver function is equally critical. The liver is a vital organ, and many treatment options for liver cancer, especially advanced cases, depend heavily on how well the liver is functioning. This is typically assessed using the Child-Pugh score, a system that categorizes liver function into three classes: A, B, or C. The higher the score, the more severe the liver damage.

For early-stage patients with Child-Pugh Class A, where the liver is still functioning relatively well, the following aggressive treatments may be options:

• Surgical resection
• Transarterial chemoembolization (TACE)
• Radiofrequency ablation (RFA)
• Liver transplantation (if eligible under criteria such as the Milan criteria)

These treatments aim to target the cancer directly and are more viable when the liver can still handle the stress of such interventions.

However, for patients with compromised liver function, treatment options become much more limited. The liver is often too weak to handle aggressive treatments or surgery. This class is typically associated with decompensated cirrhosis, where the liver can no longer perform its basic functions effectively. However, some patients with poor liver function may still be suitable for liver transplantation. Please consult your doctor for a discussion about your eligibility.

In advanced cases, many systemic therapies are not suitable for patients with severe liver dysfunction. Systemic therapies may exacerbate liver damage. Therefore, the focus shifts from curative treatments to palliative care. Although some patients may still benefit from targeted therapy or immune checkpoint inhibitors, these options are limited to those with tumors that have the appropriate biomarkers for effective treatment.

For patients with liver cancer and severe liver damage (decompensated cirrhosis), treatment options are limited. While liver transplantation offers a potential treatment option, strict selection criteria and a shortage of donor organs often restrict access. The waiting list for deceased donor livers prioritizes patients based on their MELD (Model for End-Stage Liver Disease) score. Livers are allocated to the sickest patients, including individuals without cancer.

If the waiting list for a deceased donor is too long, consider the possibility of a living donation. Since the liver has the ability to regenerate, a living donor can safely donate a portion of their liver to help someone in need. This option allows the patient to receive an organ more quickly than waiting for a deceased donation. Patients with a lower MELD score may consider reaching out to friends or family members for a living donation. However, it’s important to note that living donation is subject to compatibility factors, such as blood type and body size.

Liver cancer treatment often involves multiple steps, as the disease typically requires a combination of therapies. Depending on the stage and type of liver cancer, treatments may be staggered over time to target the disease most effectively.

For patients facing surgery, whether a hepatectomy or liver transplant, assessing the tumor’s size and location is crucial. If the tumor is too large for resection or if liver function is compromised, bridging therapies such as TACE or RFA may be employed. These procedures can be used as standalone treatments or integrated with other therapies. Additionally, they serve to shrink the tumor and help downstage it, allowing patients to meet the MELD score criteria necessary for eligibility for liver transplantation.

After surgery, doctors may prescribe systemic therapies for eligible patients to prevent recurrence. Drugs like sorafenib or lenvatinib are often used as adjuvant therapy. For those with cirrhosis or other underlying liver conditions, ongoing liver-related care remains important. This may include treatments like antiviral therapy for active hepatitis B or C infection.

For patients with advanced liver cancer, treatments may involve more than one line of therapy. Doctors typically start with first-line systemic therapy. If the disease progresses, they consider second-line treatments to continue managing the condition.

When facing a cancer diagnosis or difficulties in making treatment decisions, some patients may feel the need to seek a second opinion. However, some patients may worry about hurting their doctor’s feelings by asking for a second opinion. To tackle this concern, cancer survivor Katie Coleman took to her TikTok account and ran a poll asking, “Are you going to hurt your doctor’s feelings when you ask for a second opinion? Will they feel personal about it?”

Surprisingly, half of the respondents admitted they were worried about offending their doctors. But here’s the twist: when doctors were surveyed, the overwhelming majority reassured patients with a resounding “No!” It turns out, doctors totally get it — they understand the complexities of cancer treatment and recognize how crucial it is for patients to feel confident in their treatment decisions.

Even if no changes are made to your treatment plan, a second opinion can provide peace of mind, ensuring that you are making the best choice for your health. Be cautious of advice influenced by media or promotional content, and always rely on trusted medical professionals for guidance. Common motivations for seeking a second opinion include:

• Need for confirmation: To verify the diagnosis and treatment plan.
• Uncertainty: When the best course of treatment isn’t clear (risks and benefits), a second opinion can help guide your decision.
• Dissatisfaction with communication: If there’s a lack of clarity or difficulty understanding your current doctor.
• Desire for more personalized information: To gain tailored advice for your specific condition.

So, don’t hesitate to seek that second opinion—it’s also your right as a patient.

Clinical trials are another option worth considering, especially when conventional treatments have not been effective or when new treatments are being developed. These trials are carefully regulated research studies aimed at improving existing treatments or testing new drugs and therapies.

Participation in a clinical trial is voluntary, and while these trials offer hope, they also come with uncertainties. Some experimental drugs may not be as effective as current treatments, or they may carry unknown side effects. On the other hand, joining a clinical trial allows patients access to the latest advancements in treatment, which can be particularly beneficial if other options have been exhausted.

It’s important to weigh the potential risks and benefits of clinical trial participation. Trials are designed not only to benefit the current patient but also to advance science and improve treatment options for future generations of liver cancer patients.

Find out more about clinical trials in liver cancer here.