Surgery

Radiofrequency Ablation Therapy (RFA)

In this treatment an electrical current (made by laser or microwaves) is sent down a special needle to destroy the cancer cells by burning them. This slows the growth of the cancer, and can improve your chances of long-term survival. A small number of patients are cured with this treatment. Sometimes it is given before liver resection, which is explained below.

RFA may be carried out after you have had a local anaesthetic to numb your abdomen, and you will remain awake. Sometimes a general anaesthetic is used.

The operation may be carried out in the X-ray department or in the operating theatre. To picture the liver and help guide the doctor, ultrasound, a CT scanner or an MRI scanner is used. Sometimes an open operation on your abdomen is needed.

A fine needle is then inserted through your skin and into the centre of the tumour. Once in place, the needle opens up like the spokes of an umbrella. A powerful electrical current is then passed through the needle to burn the area and destroy the cancer cells. The needle spokes close, and the needle is withdrawn. This takes between 10-30 minutes.

To minimise the risk of bleeding, you will need to lie flat and still for 4 hours afterwards. You may be given painkillers. You will normally be able to go home the following day, but will need to rest. Expect to be off work for one week.

The main risks of this treatment are:

• bleeding, which may result in emergency surgery
• infection
• the failure to locate the tumour, leading to the treatment being abandoned.

Your doctor will discuss the risks with you beforehand.

Following the operation, your consultant will check on your progress 2-10 weeks afterwards. You will also receive an appointment for a scan, so that the size of the tumour can be checked. Further sessions of RFA may then be recommended.

Liver resection

Surgical removal of the infected part of the liver will be attempted if the tumour has not spread. It is sometimes used to treat secondary cancer too, if the cancer has spread from the bowel. Other secondary cancers of the liver are usually too widespread for surgery to be effective. For most people with liver cancer, this type of surgery is not suitable.

The surgery is called liver resection. It is a major operation, lasting between 3 and 7 hours. Most people will be able to go home after 7-10 days. Once home, you will need to take it easy for a further two to three months. Expect to be off work for 3 months.

Following liver resection a course of chemotherapy may be necessary. Your care team will discuss this with you.

The liver usually re-grows within a few months and will then function normally.

The liver is a vital organ, and cannot be completely removed.

Transplantation

Liver transplantation is rarely used in the treatment of liver cancer. This is for a combination of reasons. The cure rate is low. The drugs that stop the body rejecting the implant also interfere with the body’s natural defences, so the cancer usually comes back. And, there are not enough donors.

Resection or removal of other organs

Sometimes other organs or parts of other organs near to the liver tumour, such as the diaphragm or bowel, are removed as well. This is to try and ensure no spread of the cancer.

Surgical treatment of jaundice

Surgery may also be used to help relieve jaundice. A small tube (called a stent) is inserted into the bile duct if it is blocked.