Liver Cancer Diagnosis and Treatment

Two doctors, one male and one female, stand bedside talking to a female patient sitting up in her hospital bed.
Dr. Skye Mayo (left) and Rachel Schafer (middle), a registered nurse, are among providers who work together to care for patients with liver cancer.

The OHSU Knight Cancer Institute offers every available treatment for patients with liver cancer. You’ll find: 

  • Care from a team of specialists who work together.
  • Specialists who meet weekly at a tumor board to figure out the best treatment for each patient.
  • The most advanced techniques for delivering targeted radiation therapy.
  • The only hospital in the Pacific NW that provides hepatic arterial infusion (HAI) therapy.
  • Oregon’s only liver transplant center.
  • Access to clinical trials for promising new treatments.
Physician assistant Jeff Donovan and Dr. Charles Lopez reviewing images on screen together
Physician assistant Jeff Donovan (left) and Dr. Charles Lopez, a medical oncologist (a doctor who treats cancer with medications) look at a scan.

Diagnosing liver cancer

At the Knight Cancer Institute, our specialists have extensive experience with the latest diagnostic tools and techniques for liver cancer. We begin with a physical exam and discussion of your medical history and symptoms. Other tests may include:

  • Liver function tests measure levels of certain substances in your blood that show how well the liver is working.
  • Hepatitis tests check for infections with the hepatitis B or C virus.
  • An alpha-fetoprotein test checks for a protein produced by many liver cancers, though other conditions can also cause its levels to rise.
  • Ultrasound uses sound waves to create images of the liver and other abdominal structures. We may start with ultrasound to check for liver tumors and to decide if you need more tests.
  • CT scans, also called computed tomography scans, use special X-rays to produce 3D images. A CT scan can show the location, size and shape of tumors, confirming a liver cancer diagnosis. We may do a chest CT scan to see if cancer has spread to the lungs. 
  • MRI scans, also known as magnetic resonance imaging, use a large magnet and radio waves to create detailed images. An MRI scan can confirm a liver cancer diagnosis and find cancer that has spread.
  • Bone scans check for cancer that has spread to bones. We may recommend a bone scan for patients with advanced liver cancer. We inject a tiny amount of radioactive material that travels through the bloodstream to the bones. The material collects in cancerous cells, highlighting them on scans.

In a biopsy, doctors take a small tissue sample and look at it under a microscope to check for cancer cells. They can also see the type of cancer and judge how aggressive it might be.

Our doctors typically use a thin needle guided by an ultrasound or CT scan to remove a small sample from your liver.

Treatments for liver cancer

Treatment depends on how much of the liver is affected and whether the cancer is primary or secondary

  • Primary liver cancer begins in the liver.
  • Secondary (or metastatic) liver cancer begins in another part of the body and spreads (metastasizes) to the liver.
Dr. Brett Sheppard in the operating room performing a surgical procedure
Dr. Brett Sheppard (right) is among OHSU’s many highly trained cancer surgeons.

Surgery

We have one of the largest robotic surgery departments on the West Coast. For liver cancer, we use a range of techniques depending on your condition.

Partial hepatectomy (liver resection): Surgeons remove a small section of your liver. In most cases, the remaining liver adapts and can grow back to its original size in about three months. 

Extended and multi-stage hepatectomy: Surgeons remove a larger section of your liver. It may be done in a single session or over multiple sessions. In most cases, the remaining liver adapts and can grow back to its original size. 

Liver transplant: Surgeons remove your liver and replace it with a  healthy liver from a deceased donor. This surgery is not an option for most cancer patients. But if you have a type of liver cancer called hepatocellular carcinoma, you might qualify. OHSU is home to Oregon’s only liver transplant center.

These are serious, complex procedures that require advanced skills and experience.

Radiation therapy

A male doctor smiling in front of a window.
Dr. Nima Nabavizadeh, one of our radiation therapy doctors, takes pride in making sure his patients understand their treatment.

Radiation therapy uses beams of energy to destroy cancer cells.

For liver cancer, we use an advanced technique called stereotactic body radiation therapy, or SBRT. Advantages include:

  • Less damage to nearby healthy tissue, because the radiation is precisely targeted to the tumor.
  • More effective treatment because of higher radiation doses.
  • Shorter treatment timeframe, with five or fewer treatments over no more than two weeks.
  • Fewer side effects, including less pain after treatment.

At the Knight Cancer Institute, we use radiation therapy in three main ways:

  • To eliminate tumors: Radiation can eliminate some liver tumors. 
  • As a bridge to a transplant: Radiation can shrink tumors or stop them from growing or spreading. This is important for patients who may wait up to a year for a liver transplant. 
  • To relieve symptoms: Radiation can relieve symptoms such as pain, nausea and bleeding.

Ablation

Ablation uses a needle to deliver heat energy to destroy cancer cells. Doctors guide the needle into the tumor using advanced imaging technology.

    Ablation can help patients who have one tumor or a few small tumors. Ablation can eliminate small tumors or provide a bridge to a liver transplant.

    Techniques include:

    • Microwave ablation sends microwaves through the needle to create heat.
    • Radiofrequency ablation (RFA) sends high-frequency electrical currents through the needle to create heat.

    Embolization

    Embolization uses tiny beads to block the blood supply to liver tumors. 

    The liver has two blood supplies: the portal vein and the hepatic artery. Most normal cells get blood from the portal vein. But cancer cells get blood from the hepatic artery. So blocking the hepatic artery can starve cancer cells while protecting most normal liver cells.

    We might recommend embolization if:

    • You have several liver tumors.
    • You have a large tumor that cannot be removed with surgery.
    • You are waiting for a liver transplant.

    We offer three types of embolization:

    Your doctor uses a catheter (thin, flexible tube) inserted into a groin artery and guided to the hepatic artery in the liver. Once the catheter is in place, the doctor injects tiny particles into the artery to block blood supply to liver tumors.

    This treatment combines embolization with chemotherapy. Your doctor uses a catheter to inject tiny beads containing chemotherapy drugs into your hepatic artery. The beads block blood supply to the tumors, and then release a dose of cancer-fighting drugs.

    This treatment combines embolization with radiation therapy. Your doctor uses a catheter to place tiny beads into your hepatic artery. The beads contain a radioactive material, yttrium-90. The beads block blood supply to the tumors, and then deliver a dose of radiation directly to the cancer cells. This treatment is also known as selective internal radiation therapy (SIRT)

    Watch a patient education video about radioembolization at OHSU.

    Hepatic arterial infusion (HAI)

    The Knight Cancer Institute is one of the few West Coast cancer centers offering hepatic arterial infusion (HAI). This groundbreaking therapy provides safe, effective treatment for liver cancer, especially cancer that has spread from the colon or rectum.

    • How it works: Your doctors place an HAI pump inside your abdomen and connect it to the hepatic artery. The pump delivers a powerful dose of chemotherapy directly to your liver. This therapy attacks cancer from the inside and causes fewer side effects than standard chemotherapy.
    • Advantages: HAI can shrink liver tumors, extend life and relieve symptoms. In some cases, it can shrink the tumor enough for surgical removal. Research has shown that it may also reduce the chance of cancer coming back.

    Targeted therapy

    Targeted therapy uses cancer-fighting medications that exploit specific features to kill cancer cells. Targeted therapy for liver cancer blocks proteins that promote tumor growth or that help form blood vessels to feed the tumor. 

    Our team uses targeted therapy to treat liver tumors that have not spread but that can’t be safely removed with surgery. We also use it to control tumor growth, prolong life and relieve symptoms for patients with advanced liver cancer.

    Immunotherapy

    Immunotherapy medications harness your body’s immune system to find and kill cancer cells, while largely avoiding healthy cells. We use immunotherapy in similar ways as targeted therapy.

    Clinical trials for liver cancer

    We are constantly researching new ways to prevent, detect, diagnose or treat cancer. You may be eligible for a clinical trial of a promising treatment that isn’t widely available.

    Holistic care

    We provide many services to help you and your family, including: 

    • Rehabilitation: Our highly trained physical and occupational therapists can help you regain strength and function.
    • Palliative care: Our expert Palliative Care Service team can help you and your family deal with symptoms and anxiety.
    • Cancer social workers: Our cancer social workers can support you and your family through cancer treatment. You can call or meet with them at several locations for counseling, help navigating OHSU, or referrals to a variety of resources. 
    • Liver tumor registry: Our cancer registries, including one for liver tumors, help researchers unlock better ways to detect and treat disease. We also offer a registry for patients who have had part of their liver removed. Learn how you can participate.

    Learn more

    For patients

    Call 503-494-7999 to:

    • Request an appointment
    • Seek a second opinion
    • Ask questions

    Location

    Parking is free for patients and their visitors.

    Center for Health & Healing Building 2
    3485 S. Bond Ave.
    Portland, OR 97239

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