Treatment for Liver Tumors and Cancer

Today, there are more treatment options for liver cancer than ever before. When you come to Fred Hutchinson Cancer Center, you will have access to the full range of therapies as well as the latest innovations through clinical trials.  

At Fred Hutch, our world-class specialists treat more people with liver cancer than anywhere else in the Pacific Northwest. We care for patients with both the most common and the rarest forms of the disease. When it comes to liver cancer, our physicians are experts who use their deep knowledge and skills to give you the best possible care.

Leaders in Minimally Invasive Treatment

At Fred Hutch, we are committed to finding minimally invasive treatment options for liver cancer as much as possible. If your physician recommends a minimally invasive therapy, you may get care at the Center for Advanced Minimally Invasive Liver Oncologic Therapy (CAMILOT).

CAMILOT is the first program of its kind in the Pacific Northwest region. Our physicians partner to provide coordinated, minimally invasive treatments such as robot-assisted surgery, ablation, catheter-based therapy and radiation therapy.

Treatment Plan

Your physician may recommend surgery, thermal ablation, irreversible electroporation (IRE), embolization, chemotherapy, proton therapy or other radiation therapy, which are all available at Fred Hutch. 

Your medical oncologist will also talk with you and your caregiver about your personal preferences. Together, you will decide how to move forward.

If you have another disease, such as colorectal cancer, and it has spread to your liver, we will work closely with the team that is treating you for that disease.

How Do We Create Your Treatment Plan?

After we know the stage of your disease and understand the overall function of your liver, we can start developing your treatment plan. 

Every week, a group of liver cancer experts called the Liver Tumor Board meets to discuss patient cases and develop treatment plans. This approach means each patient benefits from the experience of the whole group. 

In addition to your Fred Hutch medical oncologist, other liver experts in this group include medical oncologists, radiation oncologists and researchers looking for better ways to treat this disease. 

Your physician, with help from the Liver Tumor Board, will:

  • Recommend the best treatment for your type of liver cancer 
  • Explain how the treatment works 
  • Tell you about any clinical trials you may want to think about

Why Do Treatment Plans Differ?

Because each person’s disease and health are unique, physicians need to customize treatment to each person. When they are making your treatment plan, our liver specialists think about many things, such as:

  • Your subtype of liver cancer 
  • If your liver cancer is slow-growing (indolent) or fast-growing (aggressive)
  • The stage of your disease
  • The overall health of your liver
  • If you’ve had treatment for liver cancer in the past
  • Your age and overall health
  • Your values, needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What Is The Standard Therapy For Liver Cancer?

Because every patient is unique and their liver is in a different stage of health, there is no standard therapy for liver cancer. 

At Fred Hutch, no matter what type of treatment you are getting, our approach always includes caring for you as a whole person. We help you get relief from any side effects you may have and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Many patients can choose to receive promising new liver cancer therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these trials. Your care team will tell you about any that might be right for you, so you can think about joining them.

Treatment Process

Based on your type of liver cancer, your team will recommend a customized treatment plan.  Once we decide on your treatment, we make sure you understand the process, how to prepare and what you can expect.


Liver cancer is treated through surgery as much as possible. A partial hepatectomy is a surgery to remove the cancerous portion of the liver. A liver transplant is a surgery to remove the entire liver and replace it with a donor liver.

Whether or not surgery is a treatment option for you depends on many things, including if you have primary liver cancer (which starts in the liver) or secondary liver cancer (which starts someplace else and spreads to your liver).

If your doctor and care team believe your cancer can be completely removed with surgery, and if you have primary liver cancer, this will probably be the treatment we will recommend to you.  However, surgery is only an option if your tumor has not spread to other parts of your body. 

Other things that your physician and the Liver Tumor Board will discuss before recommending surgery include:

  • The location of the tumor within your liver
  • How widely it has spread within your liver
  • The overall health of your liver

If you have liver cancer surgery, you will be treated at the Liver Transplant Program at UW Medical Center – Montlake.

Learn more abour Surgery

Partial Hepatectomy

If only part of your liver is removed, the surgery is called a partial hepatectomy. After surgery, your remaining healthy liver tissue will take over the function of your liver. If your healthy liver tissue is otherwise normal, it will regenerate (grow back) within several weeks.

Liver Transplant

Liver transplant is a surgery to replace your damaged liver with a healthy liver from a donor. 

Your physician may recommend a liver transplant if:

  • Your cancer is only in your liver 
  • You cannot have a partial hepatectomy because of the location of the tumor
  • Your liver is too damaged to regenerate (grow back) if the cancerous part is surgically removed

At UW Medical Center - Montlake, transplant specialists do transplants for hepatocellular carcinoma, hepatic epithelioid hemangioendothelioma, and cholangiocarcinoma, which not all transplant centers can do.

Also, UW Medical Center is the only center in the Pacific Northwest to offer living donor transplants. These transplants use liver tissue from a living person who donates part of their liver. Transplants of livers from deceased donors are also done.

Learn more about the Liver Transplant Program

Thermal Ablation

Thermal ablation is a minimally invasive procedure that uses heat to treat liver tumors. It is sometimes used with other treatments.

How thermal ablation works:

  • An interventional radiologist (a doctor who uses minimally invasive image-guided procedures to diagnose and treat diseases) or a surgeon puts a needle-like probe into the tumor. 
  • They use an ultrasound or computed tomography (CT) scan to guide the probe to the right place. 
  • Heat is created at the tip of the probe using either microwave energy (microwave ablation) or radiofrequency energy (radiofrequency ablation), and this destroys the cancer cells.

The probe can be: 

  • Passed through your skin into your liver
  • Put into your liver during surgery through small “keyhole” incisions (cuts) in your abdomen (laparoscopically), your chest (thoracoscopically) or through a larger incision, if needed
  • Moved to different spots to heat multiple tumors or to heat all areas of a larger tumor

If you need thermal ablation, it will be done at UW Medical Center – Montlake. Usually, a hospital stay is not needed.

Irreversible Electroporation

Irreversible electroporation (IRE) for liver cancer uses electrical currents to open the membrane around a cancer cell. This destroys the cell without harming the surrounding tissues. IRE (sometimes called NanoKnife treatment) can be used if thermal ablation is not an option.

IRE is done at only a few centers in the U.S. The doctors at UW Medical Center who perform it are some of the most experienced in the nation.

How IRE works:

  • An interventional radiologist or surgeon puts needle-like probes into the tumor. The probes can be passed through your skin into your liver (percutaneous IRE) or put into your liver during surgery.
  • They use an ultrasound or CT scan to guide the probe to the right place. 
  • Micropulses of electrical current are sent through the probes, making the cell membranes open, which destroys the cells.


Chemoembolization is a treatment that delivers a very strong dose of an anticancer medicine directly to the liver.

How chemoembolization works:

  • A physician called an interventional radiologist puts a catheter into an artery in your groin, then guides it into your hepatic artery. 
  • Chemotherapy medicines are put into the catheter. 
  • Then you will get other drugs that partially block the hepatic artery. This cuts off the blood supply to the tumor, so it can’t get the oxygen it needs to survive.
  • Your liver continues to get blood from another main blood vessel, called the portal vein. 

If you have chemoembolization, you will be treated at UW Medical Center – Montlake. Usually, you can go home the same day you have the procedure. However, every patient is different, and your doctor may recommend an overnight stay in the hospital.


Radioembolization can slow, stop or shrink tumors by delivering radiation directly to the cancerous cells in the liver.

How radioembolization works:

  • A physician called an interventional radiologist puts a catheter into an artery in your groin and guides it into your hepatic artery, close to your tumor. 
  • Next, very small radioactive particles are injected into the catheter. 
  • These particles become trapped inside the tumor. This blocks blood flow, and the radiation that comes from the particles damages the cancer cells.
  • Your liver continues to get blood from another main blood vessel, called the portal vein. 

If you have radioembolization, you will be treated at UW Medical Center – Montlake. Most patients can go home the same day they have the procedure. Your Fred Hutch care team is highly experienced in this treatment, performing one of the highest number of radioembolization procedures in the U.S.


When people have advanced hepatocellular carcinoma (HCC) and surgery or other types of procedures are unlikely to help them, doctors usually recommend anticancer drug treatments, like chemotherapy.

Two common medicines used to treat advanced HCC are called sorafenib (Nexavar®) and lenvatinib (Lenvima®). Regorafenib (Stivarga®) is sometimes used, too, after a patient has already been given sorafenib. 

Fred Hutch researchers are studying new ways to use these medicines along with therapies that are specifically meant for the liver. Other promising experimental medicines are also being studied.

Your Fred Hutch team will tell you about any medications that might be right for you, including ones available through clinical trials.


Immunotherapies are treatments that use your body’s own immune system to treat cancer.

If you have hepatocellular carcinoma (HCC) and you have been given sorafenib (Nexavar®), but it didn’t work, your doctor might prescribe an immunotherapy medicine called nivolumab (Opdivo). 

Other immunotherapies to treat liver cancer are being studied. One example is T-cell therapy. T cells are a type of white blood cell that help boost your body’s natural immune response to infections and tumors.

Learn more about Immunotherapy

Radiation Therapy

Radiation therapy is a noninvasive form of therapy that uses high-energy X-rays or other types of radiation to destroy cancer cells. You may have radiation therapy to help shrink tumors in your liver and control symptoms.

Some of the types of radiation therapy your physician may use are:

Conventional external-beam radiation therapy (EBRT): This therapy uses a machine called a linear accelerator to send beams of high-energy X-rays at your cancer. There are several forms of EBRT. 

Stereotactic body radiation therapy (SBRT): A type of EBRT that focuses many high-energy beams of radiation on the tumor to destroy it.

Proton therapy: Another type of EBRT that targets charged particles called protons at tumors to kill cancer cells, instead of X-rays, which are used in standard treatments. 

Protons can be aimed exactly at the tumor. Because of this, proton therapy can mean a lot less radiation exposure for nearby healthy tissue in the liver, stomach, bowel, kidneys and heart. Here are some other facts about proton therapy:

  • Proton therapy can help control tumors while reducing the side effects and complications that can happen with radiation therapy.
  • Proton therapy can be useful for people with poor liver function, very large tumors or tumors that had radiation in the past.

If your physician recommends proton therapy, you will be treated at Fred Hutchinson Cancer Center – Proton Therapy, which is the only proton treatment facility in the Pacific Northwest. 

Learn more about Proton Therapy

Monitoring Your Health

If you are not having surgery, your care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition services or mental health counseling

We will always update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Possible Results of Treatment

After your surgery or other liver cancer treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms.
  • Stable disease: No change in the extent or severity. The cancer is not going away, but it is not getting worse, either.  
  • Disease progression: The cancer is getting worse or spreading.
  • Relapse: The cancer, or its signs or symptoms, has come back after it had improved.
  • Refractory disease: The cancer does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible.

Side Effects

Side effects can be different depending on which treatment you get and other things, like how strong your immune system is and the condition of your liver. 

For instance, thermal ablation may cause abdominal pain and a fever. If you are having chemotherapy, you might get nausea, diarrhea or hair loss. If you had surgery, you could have bleeding or infection. 

You are always at the center of everything we do. Our physicians, nurses and advanced practice providers are here to help prevent or relieve side effects of treatment. 


When you have liver cancer, it is important to include specific nutrition in your diet. This can help you avoid problems with how well your liver works. For example:

  • You may not be able to digest food as well as you used to, but some proteins can help your digestion. 
  • When you have liver cancer, you may have less energy and need to eat often throughout the day. This is because your liver may not store glycogen as well as it does when it is healthy. 
  • If you have fluid build-up in your abdomen, too much sodium may be part of the problem. Because of this, a low-sodium diet can help.

A Fred Hutch registered dietitian can help you understand and choose nutrition that will be best for you.

Learn more about Nutrition

“At Fred Hutch, we are able to offer the best minimally invasive treatment options for patients with liver cancer. These treatments have many benefits, including improved quality of life, reduced risk of complications and faster recovery times. As physicians, we recognize the significance of these treatments and strive to provide our patients with the most advanced, least invasive options available.”

— Guy E. Johnson MD, PharmD, Radiologist, UW Medicine

Supportive Care Services

Along with treating your liver cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to physical therapists, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.

Learn more about Supportive Care

Caregiving Before and After Surgery

If your loved one is having a partial hepatectomy or liver transplant, there are many things you can do to help them get ready for their surgery, as well as help them during their recovery. 

  • Help your loved one stay organized by making a care checklist.
  • Help prevent infection by doing things like washing hands frequently and staying away from people who are sick.
  • After surgery, watch for any problems and report them to a physician right away.

Caregiving During Treatment Other Than Surgery

If the person you are caring for is having a treatment besides surgery, such as thermal ablation or immunotherapy, there are many ways you can help. Caregiving often means doing tasks like these:

  • Keeping track of their appointments, and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of tasks that they may not be able to do by themselves, like grocery shopping and cleaning

Continuing Care

After your surgery, or when your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your liver cancer. They will check if you need more post-surgery treatment to reduce the risk of cancer recurrence and make a plan for surveillance (monitoring your health).

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your medical oncologist will base your schedule on many things, including:

  • The condition of your liver
  • If your disease was slow-growing (indolent) or fast-growing (aggressive)
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least five years and, if needed, on a case-by-case basis after that.

What Happens at Follow-up Visits

Follow-up for liver cancer usually means seeing your medical oncologist for a physical exam and having blood tests and surveillance imaging. If there are any changes, your team will make the right plan for you.

After your treatment is over, team members at the Fred Hutch Survivorship Clinic will help you live your healthiest life as a liver cancer survivor.

Learn more about Fred Hutch Survivorship Clinic

Meet the Liver Tumors and Cancer Care Team