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.
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.
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.
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:
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:
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.
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:
If you have liver cancer surgery, you will be treated at the Liver Transplant Program at UW Medical Center – Montlake.
Learn more abour Surgery
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 is a surgery to replace your damaged liver with a healthy liver from a donor.
Your physician may recommend a liver transplant if:
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 is a minimally invasive procedure that uses heat to treat liver tumors. It is sometimes used with other treatments.
How thermal ablation works:
The probe can be:
If you need thermal ablation, it will be done at UW Medical Center – Montlake. Usually, a hospital stay is not needed.
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:
Chemoembolization is a treatment that delivers a very strong dose of an anticancer medicine directly to the liver.
How chemoembolization works:
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:
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 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:
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
If you are not having surgery, your care team will see you regularly for exams and tests to check:
We will always update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.
— Guy E. Johnson MD, PharmD, Radiologist, UW Medicine
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
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).