Liver Cancer Surgery: Types, Recovery and What’s Next

Cancer is an unfortunate fact of biology that arises when cellular mutations lead to unchecked proliferation. Cancer can occur in virtually any cell in the body, from blood and brain to skin and lungs.

One particularly dangerous form of cancer is liver cancer. Cancer of this large, wedge-shaped organ located under the right ribs and lung is often diagnosed in later stages, once it’s started spreading to other organs. Later-stage cancers are more difficult to treat than if the cancer is caught early. Thus, the five-year relative survival rate for all stages of liver cancer is 18%, the American Cancer Society reports. However, that rate rises to 33% in early-stage cases of liver cancer because surgical procedures can help people recover.

[See: 10 Innovations in Cancer Therapy. ]

Types of Liver Cancer

Cancerous tumors can develop on the liver and spread to other parts of the body, and this may occur without the patient realizing it because sometimes symptoms are vague or mild and go undetected.

But liver cancer isn’t a singular entity. “There are two main types of cancer that can form directly from the liver itself,” says Dr. Aslam Ejaz, a surgical oncologist with the Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus.

These two primary types of liver cancer are:

Hepatocellular Carcinoma

The most common type of primary liver cancer, HCC usually occurs in people who have another chronic liver disease such as cirrhosis (scarring of the liver that may be related to alcohol abuse or another issue), hepatitis B or hepatitis C infections.

Dr. James J. Lee, a gastroenterologist with St. Joseph Hospital in Orange, California, says hepatitis B and C infections are dangerous because they cause “progressive liver damage, which can result in cirrhosis and liver failure as well as hepatoma,” another name for HCC. These diseases are caused by blood-borne viruses that are highly contagious. They cause acute inflammation in the liver that leads to scarring (cirrhosis) and may open the door cancer.

No matter the cause, treatment for HCC may include surgery, liver transplant, chemotherapy, radiation, immunotherapy, targeted drug therapies or ablation (destruction) of cancer cells through the application of heat, cold or electrical current. You may undergo a combination of several treatments depending on your specific diagnosis.

Cholangiocarcinoma

This form of cancerous tumor develops in the bile ducts, the slender tubes that connect the liver to the gallbladder and small intestines. These ducts carry bile, a digestive fluid. Cholangiocarcinoma is also called bile-duct cancer, and it’s the second most common liver cancer, accounting for about 10% to 20% of primary liver tumors.

Tumors may develop in the bile ducts after small mutations in cells add up to rapid proliferation of malignant cells. Risk factors for developing this kind of cancer include:

Chronic liver disease. Cirrhosis caused by a history of chronic liver disease is a major risk factor for bile-duct cancer.

Primary sclerosing cholangitis. This disease causes the bile ducts to harden and scar.

Malformed bile ducts. Some people have congenital defects to the bile ducts that increase risk of developing cancer there.

Parasites. Infestation with certain organisms, such as liver flukes — which are very rare in the U.S. but can be introduced to the body via consumption of undercooked or raw fish — can damage the liver and bile ducts and potentially lead to cancer.

Age and lifestyle. This type of cancer is more common in adults over age 50. It’s also experienced more commonly among smokers.

Bile-duct cancer tends to be more aggressive than HCC, and thus has a worse prognosis. However, it may be treated with surgery, radiation, chemotherapy or other targeted drug therapies.

[SEE: Alcoholic Hepatitis Symptoms: Here’s What You Need to Know.]

Types of Surgery for Liver Cancer

If your doctor suspects you have liver cancer, you’ll undergo extensive testing to determine what type and stage cancer you have and to determine the location of the tumor or tumors. “Ultrasound or CT scans of the liver” may be part of that process, Lee says.

If you’re diagnosed with liver cancer, your doctor may have the option of a few types of surgical procedures to treat them. The choice of procedure will “depend on the general health of the patient as well as the type, size and number of liver tumors there are,” Ejaz says.

Surgery for liver cancer generally takes one of the following forms:

Partial Hepatectomy

This procedure, also called a liver resection, removes part of the liver. It’s only for patients who have good liver function and have a single tumor that hasn’t yet grown into blood vessels.

“Surgical removal of liver cancer is performed on patients who are in good health and those that have tumors that, once removed, would leave a healthy amount of liver behind,” Ejaz notes.

It’s not a good option for someone who has severe cirrhosis, a condition that causes scarring of the liver. The ACS reports that most people who have liver cancer also have cirrhosis, so your doctor will perform some additional imaging tests, such as an MRI or CT scan and blood test to check your liver function and determine the size and location of the liver tumor prior to recommending this form of surgery. If it’s determined that you’ll have at least 30% of liver function remaining after surgery, you may get the green light for this procedure.

This surgery can be performed either as open surgery or using a minimally-invasive approach. “Minimally-invasive liver surgery is performed through small keyhole incisions whereas an open operation requires a large incision on the abdomen,” Ejaz says.

Liver surgery is serious business, and while it can extend your life, there are also risks. “The main risks of liver removal include bleeding, infection, leakage of bile and liver failure, although this is a rare occurrence,” Ejaz says. Some patients also experience complications of anesthesia or may develop pneumonia.

If you’re undergoing a partial hepatectomy for liver cancer, expect to be in the hospital “anywhere from one day to one week,” Ejaz says. “In general, recovery is dependent on how healthy you are going into surgery, as well as the amount of liver removed.” In some cases, physical therapy may be indicated, especially if you have other, compounding medical problems or physical limitations. Physical therapy can be used “to enhance your recovery after surgery,” Ejaz says.

Your doctor will follow up with you regularly to check for recurrence of the cancer and other health issues that could arise. But, if you follow your doctor’s orders, “most patients return to their previous health state and quality of life” after surgery for liver cancer, Ejaz says.

A 2016 study in the World Journal of Surgical Oncology found that patients who underwent liver resection surgery had good long-term survival rates. The one-year survival rate was 89.0%, the three-year survival rate was 64.3%, and the five-year survival rate was 53.0%.

Ablation

Ablation procedures use heat, cold or electrical current to kill cancerous liver cells. These procedures are usually best suited for patients who have a few small tumors and when surgery is not a good option because of poor overall health or reduced liver function because of chronic liver disease.

There are several ways that ablation can be conducted, including:

Radio-frequency ablation. This form of ablation uses high-energy radio waves to destroy small tumors on the liver. A 2016 study of 320 patients who had radio-frequency ablation found that the cancer eventually came back in 73 (64%) patients. The five- and 10-year overall survival rates were 38.5% and 23.4%.

Microwave ablation. This approach uses electromagnetic waves to heat up tumor cells and destroy them. A 2015 study found that this procedure also has good long-term survival outcomes, and that local recurrence rates were low for tumors of less than 3 cm in diameter.

Ethanol ablation. Also known as percutaneous ethanol injection, this procedure uses concentrated ethanol, a type of alcohol, which is injected into the tumor. This is one of the least invasive and least expensive ways to treat liver cancer, and it’s best suited for tumors of 3 cm diameter or smaller. One study noted that among 746 patients with HCC, the 1-, 2-, 3-, 4-, and 5-year survival rates after ethanol ablation were 93%, 77%, 60%, 40% and 33% respectively.

Irreversible electroporation. A recently developed therapy, IRE uses electrical pulses to damage tumor cells. This type of treatment may be best suited for patients who have tumors smaller than 5 cm that are located near blood vessels. Heat ablation techniques can damage those vessels, so low-energy ablation such as can be achieved with IRE may be a better option. However, a 2017 study in the journal Medicine noted that it’s still not the first choice of ablation procedure for many patients with HCC because it requires general anesthesia and muscle blockers because the electrical current can cause muscle stimulation during the procedure that could become dangerous. Another 2017 study found that the median survival rate for HCC patients was 26.8 months post-procedure. Patients with primary HCC, rather than liver metastases that have spread from another primary cancer, seemed to have better results from IRE according to that study, likely because of a difference in cellular biology between primary and metastatic tumors.

Cryoablation. Cryoablation uses extreme cold produced by liquid nitrogen to freeze cancerous tissue. One-year survival rates range from 82.4% to 94% for cryoablation. The three-year survival rate ranged from 32.3 to 40%, and five-year rates are between 13.4% to 20% depending on the report. Cryoablation may have higher complication rates, but can be used on larger tumors than some of these other approaches.

Ablation techniques use a long needle or probe to penetrate the tumor through the abdomen. As such, it’s a less invasive procedure than other forms of surgery for liver cancer. Patients can often go home the same day.

You may have some pain in your abdomen or right shoulder — a condition called referred pain — for a few days after the procedure. Your doctor will follow up with tests soon after the procedure to see how well it worked.

You’ll need to take it easy for several days after the procedure and avoid lifting heavy objects and strenuous exercise. You may be advised not to drive or go to work for up to a week or two, depending on your specific situation.

[READ: 5 Ways to Detox Your Liver That Really Work.]

Liver Transplant

In certain cases, a liver transplant might be the best option for tumors that can’t be removed or would not leave enough functional liver tissue behind after removal. In this procedure, the surgeon removes your entire liver and replaces it with healthy liver tissue from a donor. Procuring a healthy liver matching the patient’s blood type in a timely fashion can be a major difficulty.

But, unlike other organs that must be harvested from a recently deceased donor, it’s possible to transplant a piece of a live donor’s liver. The liver has a miraculous ability to regenerate, and if a section is removed and implanted in a patient, both the donor and the recipient can regenerate what’s missing and return to normal function within several weeks.

Still, a liver transplant is major surgery that carries risks. If you’re going to have a liver transplant, expect to remain in the intensive care unit for a few days. You may be in the hospital for up to two weeks in total, and you’ll need frequent check-ups with your surgical team afterwards to ensure that the transplant is taking and liver function is resuming normal levels. Physical therapy may be part of your recovery plan.

You’ll also have to remain on powerful immunosuppressant medications for the rest of your life to subdue the body’s urge to reject the new organ. These medications can cause side effects, including gastrointestinal problems. They may also make you more susceptible to other infections, so these powerful medications must be managed carefully.

Aftercare

After surgery for liver cancer, it’s important that you take good care of your health. This includes:

Getting plenty of rest. Sleep is a powerful healer. Strive to get plenty of good-quality shut-eye.

Exercising. Once your doctor has cleared you for physical activity, you should aim to move as much as you can. Getting the body moving has been shown to reduce the chances of blood clots forming or developing pneumonia.

Eating right. To support your body as it heals, be sure to provide it with healthy, nutritious food and plenty of water. Within the first few days of surgery, you’ll likely be on a liquid diet, to put less strain on your body and digestive system. When you can transition back to a more standard diet, be sure to avoid alcohol and high-fat foods that can be difficult for the liver to process.

Managing constipation. Constipation can become a problem for some patients post-surgery. Your surgical team will likely brief you on how to manage this potential problem ahead of time, but speak up if it becomes uncomfortable.

Keeping your incision clean. For those who have open surgery or a transplant, caring for your incision and preventing infection is vitally important. Follow your doctor’s post-surgical orders carefully.

Communicating with your health care team. If you’re having pain or other issues, be sure to let your doctor know right away.

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Liver Cancer Surgery: Types, Recovery and What’s Next originally appeared on usnews.com

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