Liver Cancer

ON THIS PAGE: You will find a basic drawing of the location of the liver in the body. To see other pages, use the menu.

Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and Prevention . It describes the factors that may increase the chance of developing liver cancer and ways to lower your risk. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for liver cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

• Identify people who may need more frequent screening or a different type of screening because they have a higher risk of developing cancer due to genetic mutations, hereditary syndromes, or family history

Learn more about the basics of cancer screening .

How are people screened for liver cancer?

If you know you have cirrhosis or other risk factors , it is extremely important to talk with your doctor about whether you should be regularly screened for liver cancer. Finding a cancer before any symptoms have developed will increase the chance of successful treatment. Hepatologists are the doctors with the most experience in screening for primary liver cancer. You may also see the term “surveillance” used to explain this, but this means the same as screening.

Screening options for liver cancer include testing the blood for a substance called alpha-fetoprotein (AFP), which may be produced by cancer cells, or having imaging tests like an ultrasound, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI). More information about these tests can be found in the Diagnosis section.

Talk with a hepatologist about which screening tests they recommend and how often to have them based on your medical history. Different guidelines apply to different causes of liver disease.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems liver cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible or recommended, the doctor may suggest other tests that will help make a diagnosis.

How liver cancer is diagnosed

There are different tests used for diagnosing liver cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose hepatocellular carcinoma (HCC):

• Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check for lumps, swelling, or other changes in the liver, spleen, and other nearby organs. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, including yellowing of the skin and whites of the eyes.

• Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called alpha-fetoprotein (AFP). In the United States, AFP is found in elevated levels in the blood of about 50% to 70% of people who have HCC. The doctor will also test the person’s blood to see if there is hepatitis B or C. Other blood tests can show how well the liver is working.

In addition, other tests are commonly needed to diagnose HCC, to find where the tumor is located in the liver, and to see if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend 1 or more of the following tests:

• Ultrasound. An ultrasound creates a picture of the internal organs using sound waves. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.

• Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional image of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Often, HCC can be diagnosed based on features specific to the cancer that are seen on a CT scan. This helps patients avoid a liver biopsy (see below). A CT scan can be used to measure the tumor’s size.

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

• Angiogram. An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.

• Laparoscopy. Laparoscopy is a test that shows the inside of the body using a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Sedation uses medication to make the person relaxed and sleepy. Local anesthetic is also used to numb the area. Laparoscopy is used very rarely in diagnosing liver cancer.

• Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
  
  The type of biopsy performed will depend on the location of the cancer. The biopsy can be done during a laparoscopy, a fine-needle aspiration, or a core biopsy. During a fine-needle aspiration, cells are removed using a thin needle inserted into the tumor. A core biopsy uses a thicker needle. Either procedure is done by a radiologist who uses an ultrasound to direct the needle to the particular part of the liver with the tumor. The actual biopsy procedure usually lasts for less than 1 minute. It is typically not painful, and few people have complications from the procedure.
  
  Before the biopsy, your doctor will test your blood to make sure it clots normally. This decreases the risk of bleeding after the procedure. Sometimes, your doctor might perform a laparoscopy and biopsy to look at the non-cancerous part of the liver to find out if you have cirrhosis, which will help determine the best treatment options.

  • When the AFP blood test, CT scan, or MRI strongly indicates HCC and other test results are typical of HCC, a biopsy may not be needed. Also, most surgeons will recommend that a biopsy be done as part of surgery if all or part of the liver is being removed rather than as a separate procedure beforehand. See the Types of Treatment section for more information about surgery for liver cancer.

    It is also important to note that with newer imaging methods, very small masses are easier to find. However, it is not always possible to identify what a very small mass is and whether it is cancer. In these instances, especially when the mass is 1 centimeter or smaller in size, the doctor may recommend a “watch and wait” approach. This is also called active surveillance or watchful waiting. This means that the scans are repeated in 3 to 6 months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, the doctor will then do a biopsy.

• Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Types of Treatment ).

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is HCC, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different treatments doctors use for people with liver cancer. Use the menu to see other pages.

This section explains the treatments, also known as therapies, that are the standard of care for hepatocellular carcinoma (HCC). “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for liver cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How liver cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors:

• How much of the liver is affected by the cancer

• Whether the cancer has spread

• The patient’s preferences and overall health

• The damage to the remaining cancer-free area of the liver

When a tumor is found at an early stage and the patient’s liver is working well, treatment is aimed at trying to eliminate the cancer. The care plan may also include treatment for symptoms and side effects, an important part of cancer care. When liver cancer is found at a later stage, or the patient’s liver is not working well, the patient and doctor should talk about the goals of each treatment recommendation. At this point, the goals of treatment may focus on slowing the growth of the cancer and relieving symptoms to improve quality of life.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called "shared decision-making." Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for liver cancer because there are different treatment options. Learn more about making treatment decisions .

The various disease-directed treatment options for liver cancer can be grouped according to whether they may cure the cancer, or if they will improve survival but will most likely not eliminate the cancer. Descriptions of the most common treatment options, both disease-directed and those aimed at managing side effects and symptoms, are listed below.

READ MORE BELOW:

• Disease-directed treatments to eliminate and potentially cure HCC

  • Surgery

  • Radiofrequency ablation (RFA)

  • Percutaneous ethanol injection

  • Radiation therapy

• Disease-directed treatments to help patients live longer

  • Chemoembolization and radioembolization for disease confined to the liver

• Systemic therapy for advanced HCC

  • Targeted therapy

  • Immunotherapy

  • Clinical trials

• Physical, emotional, social, and financial effects of cancer

• Metastatic HCC

• Remission and the chance of recurrence

• If treatment does not work

Disease-directed treatments to eliminate and potentially cure HCC

These treatments are most likely to be recommended when the tumor has been found at an early stage. They may not be recommended to treat later stages of disease. These treatments are surgery, radiofrequency ablation, percutaneous ethanol injection, and radiation therapy.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with good liver function and tumors that can be safely removed from a limited portion of the liver. Surgery may not be an option if the tumor takes up too much of the liver, the liver is too damaged, the tumor has spread outside of the liver, or if the patient has other serious illnesses.

A surgical oncologist is a doctor who specializes in treating cancer using surgery. A hepatobiliary surgeon also has specialized training in surgery on the liver and pancreas. Sometimes, liver transplant surgeons are involved in these operations. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery .

Two types of surgery are used to treat HCC:

• Hepatectomy. When a portion of the liver is removed, the surgery is called a hepatectomy. A hepatectomy can be done only if the cancer is in 1 part of the liver and the liver is working well. The remaining section of liver takes over the functions of the entire liver. The liver may grow back to its normal size within a few weeks. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small.

  The side effects of a hepatectomy may include pain, weakness, fatigue, and temporary liver failure. The health care team will watch for signs of bleeding, infection, liver failure, or other problems that need immediate treatment.

• Liver transplantation. Sometimes, a liver transplantation can be done. This is a surgery in which the patient's liver is removed and replaced by healthy liver tissue from a donor. This procedure is possible only when specific criteria are met, including having a certain tumor size and number of tumors and whether a suitable donor is found. These criteria are usually either having a single tumor that is 5 cm or smaller or having 3 or fewer tumors, all of which are smaller than 3 cm. It is important to note that the number of available donor livers is very limited, so transplantation is not always an option.

  After a transplant, the patient will be watched closely for signs that the body might be rejecting the new liver or that the tumor has come back. The patient must take medication to prevent rejection. These drugs can cause side effects, such as puffiness in the face, high blood pressure, or increased body hair. Liver transplant has significant risks of serious complications, including death from infection, the body's rejection of the donor liver, and the possibility of an increased risk of other unrelated cancers.

  Liver transplantation is a particularly effective treatment for people with a small tumor because transplantation removes the tumor and the damaged liver. However, there are few donors, and people waiting for a liver transplant may have to wait for a long time before a liver becomes available. During this time, the disease may get worse. The transplant center will advise you on how long the wait is likely to be and what rules are used to prioritize people on the waiting list.

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Radiofrequency ablation (RFA)

RFA and microwave therapy both use heat to destroy cancer cells. They may be given through the skin, through laparoscopy, or during a surgical operation while a patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy. This treatment approach is also called thermal ablation.

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Percutaneous ethanol injection

Percutaneous ethanol injection is when alcohol is injected directly into the liver tumor to destroy it. Side effects include fever and pain after the procedure. In general, the procedure is simple, safe, and particularly effective for a tumor smaller than 3 centimeters (cm). However, if the alcohol escapes from the liver, a person may have brief but severe pain. This option is rarely used and has been largely replaced by RFA (see above).

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

• Stereotactic body radiation therapy (SBRT). SBRT is a term that describes several methods of delivering high doses of radiation therapy to a tumor while limiting the amount of radiation to nearby healthy tissue. This is important because healthy liver tissue can be damaged by radiation. SBRT effectively treats tumors that are about 5 cm or smaller. However, it is still considered investigational compared to RFA (see above) because there is not much available information about its long-term effectiveness.

Side effects of SBRT may include damage to the stomach and lungs. However, these side effects can often be prevented. Talk with your health care team about avoiding and managing possible side effects. Learn more about the basics of radiation therapy .

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Disease-directed treatments to help patients live longer

If the doctor feels the cancer cannot be cured using the treatments listed above or if the cancer is at a more advanced stage, the doctor may recommend one of the following options to shrink the tumor and/or slow tumor growth. While these treatments will most likely not eliminate the cancer, they have been shown to extend how long patients can live.

Chemoembolization and radioembolization for disease confined to the liver

Chemoembolization is a type of chemotherapy treatment that is similar to hepatic arterial infusion (see below). Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. During chemoembolization, drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also destroys cancer cells.

In addition to being used as a primary treatment for HCC, chemoembolization may be used to slow tumor growth for people who are on the waiting list for liver transplantation (see "Surgery," above).

Radioembolization is similar to chemoembolization, except that during radioembolization, a doctor places radioactive beads into the artery that supplies the tumor with blood. The beads deliver radiation therapy directly into the tumor when they become trapped in the small blood vessels of the tumor.

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Systemic therapy for advanced HCC

The treatment plan for later-stage HCC may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle, an injection into a muscle or under the skin, or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for advanced HCC include:

• Targeted therapy

• Immunotherapy

The first-line treatment is the initial treatment given. First-line therapy options for advanced HCC include:

• The combination of bevacizumab (Avastin; see “Targeted therapy” below) with atezolizumab (Tecentriq; see "Immunotherapy" below) may be offered to some patients with advanced HCC.

• Targeted therapy with sorafenib (Nexavar) or lenvatinib (Lenvima) may be offered to people who are unable to receive atezolizumab with bevacizumab. See more under “Targeted therapy” below.

• Immunotherapy with tremelimumab (Imjudo) and durvalumab (Imfinzi) may be offered to people with HCC that cannot be removed with surgery. See more under "Immunotherapy" below.

A second-line treatment is given if the first-line treatment does not work. Second-line therapy options for advanced HCC include:

• Sorafenib

• Lenvatinib

• Cabozantinib (Cabometyx; a targeted therapy)

• Regorafenib (Stivarga; a targeted therapy)

• Ramucirumab (Cyramza; a targeted therapy)

• The combination of atezolizumab and bevacizumab

• Pembrolizumab (Keytruda) or nivolumab (Opdivo), which are a type of drug called immune checkpoint inhibitors (see “Immunotherapy” below)

This information is based on the ASCO guideline, “ Systemic Therapy for Advanced Hepatocellular Carcinoma.” Please note that this link takes you to another ASCO website.

Targeted therapies and immunotherapies are discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. The medications used to treat cancer are continually being evaluated. Your doctor may suggest clinical trials that are studying new ways to treat HCC.

Talking with your doctor is often the best way to learn about the medications that can be prescribed for you, their purpose, and their potential side effects. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Targeted therapy

Targeted therapy is treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

For HCC, anti-angiogenesis drugs are the most common type of targeted therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Some anti-angiogenesis therapies are for people with unresectable HCC. Unresectable means that surgery is not an option.

Anti-angiogenesis therapies include:

• Bevacizumab with atezolizumab. In 2020, the U.S. Food and Drug Administration (FDA) approved the combination of the anti-angiogenesis targeted therapy, bevacizumab, with atezolizumab, an immunotherapy drug (see "Immunotherapy" below), for people with unresectable or metastatic HCC who have not received previous cancer treatment using medications. Unlike many anti-angiogenesis therapies, which are taken as pills, bevacizumab is given intravenously.

• Lenvatinib. In 2018, the FDA approved an anti-angiogenesis targeted therapy called lenvatinib. This drug is approved as a first treatment for HCC that cannot be removed by surgery. It is taken as a pill that is swallowed (orally).

• Sorafenib. Sorafenib is used to treat advanced HCC that cannot be completely removed with surgery. It is taken as a pill that is swallowed (orally).

• Ramucirumab. Ramucirumab is another anti-angiogenesis therapy approved for treating HCC that has high levels of the tumor marker alpha-fetoprotein (AFP) for patients who have already received sorafenib. It is given intravenously.

• Cabozantinib. In 2019, the FDA approved the use of cabozantinib to treat HCC for people who have previously received sorafenib. It is taken as a pill that is swallowed (orally).

• Regorafenib. In 2017, the FDA approved the use of another targeted therapy, regorafenib, to treat people with HCC that was previously treated with sorafenib. Regorafenib also inhibits angiogenesis. It is taken as a pill that is swallowed (orally).

Side effects of targeted therapy can vary but may include high blood pressure, back pain, headaches, changes in taste, fatigue, diarrhea, appetite loss, joint and muscle pain, weight loss, abdominal pain, rash, redness, itching or peeling of the skin on the hands and feet, hoarseness, bleeding, change in thyroid hormone levels, and nausea. Talk with your doctor about the possible side effects for a specific medication and how they can be managed.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. One common type of immunotherapy is called an immune checkpoint inhibitor. Immune checkpoint inhibitors work by blocking the pathways that would otherwise allow the cancer to hide from the immune system.

Immunotherapies for HCC include:

• Nivolumab. In 2017, the FDA approved an immunotherapy called nivolumab for the treatment of HCC. Nivolumab can be used to treat people who have already been treated with sorafenib, which is a type of targeted therapy.

• Pembrolizumab. In 2018, the FDA approved the immunotherapy pembrolizumab for the treatment of people with HCC. Like nivolumab, pembrolizumab can be used to treat people who have previously been treated with sorafenib. Pembrolizumab is an immune checkpoint inhibitor.

• Nivolumab with ipilimumab (Yervoy). In 2020, the FDA approved the use of the combination of nivolumab with another immunotherapy drug called ipilimumab (Yervoy) to treat patients with HCC who have already been treated with sorafenib. Both nivolumab and ipilimumab are a type of immunotherapy called immune checkpoint inhibitors, which means they work to block the pathways that would otherwise allow the cancer to hide from the immune system. Both nivolumab and ipilimumab are immune checkpoint inhibitors.

• Atezolizumab with bevacizumab. In 2020, the FDA approved the use of the combination of atezolizumab, an immunotherapy drug, with bevacizumab, a targeted therapy drug, for people with unresectable or metastatic HCC who have not received previous cancer treatment using medications. Atezolizumab is an immune checkpoint inhibitor, and bevacizumab is an anti-angiogenesis therapy (see "Targeted therapy" above).

• Tremelimumab and durvalumab. In 2022, the FDA approved the combination of 2 immunotherapy drugs, tremelimumab and durvalumab, for the treatment of people with HCC that cannot be removed with surgery. Both tremelimumab and durvalumab are immune checkpoint inhibitors.

Other immunotherapy drugs, including durvalumab (Imfinzi) and tremelimumab, are still being studied in clinical trials but have shown promise in treating HCC. Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your health care team about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Clinical trials

In addition to the treatment options described above, your doctor may suggest participating in a clinical trial that is evaluating a new treatment approach for HCC. This is particularly important for a disease like advanced HCC, where options for treating the disease are very limited and there is ongoing research to find more treatment options. Learn more about the Latest Research areas in HCC.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as surgery or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic HCC

If HCC has spread to another location in the body, it is called metastatic cancer. People with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment so you are comfortable with your chosen treatment plan and cancer care team. This discussion may include clinical trials studying new treatments.

Your treatment plan may include a combination of surgery, targeted therapy, radiation therapy, and/or other options. At this stage, the goal of treatment is typically to slow the cancer’s growth. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent liver cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief, fear, or disappointment that the first treatment did not entirely eliminate the cancer. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about liver cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about liver cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with liver cancer. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Cancer vaccines. Cancer vaccines are treatments that may help the immune system recognize and attack hepatocellular carcinoma (HCC) cells. Sometimes the vaccine is given with an immune system stimulant, such as sargramostim (Leukine, Prokine).

• Combining systemic cancer medications. Different drugs destroy cancer cells in different ways. Using a combination of drugs can increase the chance that more cancer cells will be destroyed. Many times, 1 drug will help another drug work better.

• Combining other therapies. Researchers are looking into whether combining treatments, such as radiofrequency ablation (RFA) and chemoembolization, is more effective than using these treatments separately.

• Anti-angiogenesis drugs. In addition to sorafenib and regorafenib, which are discussed in Types of Treatment , several other anti-angiogenic drugs are being studied in clinical trials.

• Greater use of liver transplantation. Researchers are investigating the possibility of expanding the criteria for liver transplantation for HCC. This would make more patients eligible for the procedure.

• Gene therapy. This new treatment changes a gene to fight cancer. Although gene therapy is in the very early stages of development, some clinical trials are already underway. In one example, the new gene makes chemotherapy work better. In this type of treatment, a gene can be directly injected into the tumor. The doctor then gives the patient an inactive drug, and the new gene helps activate the drug in the tumor. This approach is also being tested in combination with the other treatments listed above.

• Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current HCC treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in liver cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to review news and information about liver cancer, including research announced at recent scientific meetings.

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Research to find ways to prevent second cancers and recurrent hepatocellular carcinoma (HCC) is ongoing, but there is no standard prevention method at this time.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type and subtype of liver cancer do I have?

• How large is the tumor?

• What is the stage of my cancer? What does this mean?

• Can the tumor be removed surgically? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about risk factors

• Do I have cirrhosis of the liver? What does this mean?

• Do I have nonalcoholic fatty liver disease (NAFLD)? What does this mean?

• Am I a carrier of hepatitis B or C? What does this mean?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What types of research are being done for liver cancer in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the chances for success with the planned treatment?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Do I need to start treatment right away?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• How much of my liver will be removed?

• Will I need a liver transplant?

• If I need a liver transplant, am I likely to be prioritized on the transplant waiting list? How long should I expect to wait?

• How long will the operation take?

• Will I need to stay in the hospital for this surgery? If so, for how long?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible side effects of my surgery, in the short term and the long term?

Questions to ask about chemotherapy, targeted therapy, and immunotherapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How will it be delivered (through an intravenous (IV) tube, a catheter, or a pill)?

• What does the preparation for this treatment involve?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve these side effects?

Questions to ask about having radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve these side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.