Liver Cancer Diagnosis and Treatment

Dr. Brett Sheppard talking with a patient in clinic
Dr. Brett Sheppard is a cancer surgeon with expertise in treating both primary and secondary liver cancers. He is also a cancer researcher with a focus on early detection.

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 to go over treatment recommendations, one patient at a time.
  • The most advanced techniques for delivering targeted radiation therapy and specialized chemotherapy for liver cancer.
  • Oregon’s only liver transplant center, for some early-stage cancers.
  • Access to clinical trials testing promising liver cancer 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 take a small liver sample.

Primary liver cancer: Doctors can often confirm primary liver cancer, which starts in the liver, with imaging alone. Some patients need a biopsy, though.

Secondary liver cancer: Patients with secondary liver cancer, which spreads from elsewhere in the body, usually need a biopsy. Results tell doctors where the cancer started, guiding treatment.

Treatments for liver cancer

Treatment depends on how much of the liver is affected and whether the cancer is primary or secondary. We offer every treatment option available for all types of liver cancers.

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 typically do surgery to remove early-stage cancer that:

  • Has not spread to blood vessels or outside the liver.
  • Has formed a tumor or tumors in only a few areas of the liver.

OHSU offers two main types of surgery for liver cancer:

Partial hepatectomy: This surgery, also called a liver resection, removes a single tumor. We also take out additional tissue, sometimes a narrow border of healthy tissue and sometimes a larger section of liver. The remaining liver takes over functions and can grow back to its original size within weeks. 

Liver transplant: Your liver is replaced with an entire liver from a deceased donor or a section of liver from a living donor. A transplant may be appropriate after chemotherapy or radiation therapy for patients:

  • With one or a few small tumors.
  • With cancer that hasn’t spread.
  • When a partial hepatectomy isn’t possible.

OHSU is home to Oregon’s only liver transplant center. Liver transplant and partial removal are serious, complex procedures requiring advanced skills and experience. Our surgeons do many of these surgeries a year, leading to better outcomes for you.

Radiation therapy

Radiation therapy uses beams of radioactive energy to destroy cancer cells. For liver cancer, external beam therapy, with radiation from a machine outside your body, is most effective. 

Since 2007, our radiation oncologists have used an advanced type 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, our liver cancer team uses radiation therapy in three main ways:

  • As a bridge to a transplant: Radiation therapy can shrink tumors or prevent them from growing or spreading. Controlling tumor growth is important for patients who may wait up to a year for a liver transplant. 
  • To eliminate tumors: Radiation therapy, particularly SBRT, can eliminate some liver tumors. 
  • To relieve symptoms: In patients with liver cancer that has spread, radiation therapy can relieve symptoms such as pain, nausea and bleeding.

Ablation

Ablation uses a needle to deliver heat or cold energy to destroy cancer cells. Doctors use imaging to guide the needle into the tumor. Your care team will coordinate with our specialists in interventional radiology. Techniques include:

  • Radiofrequency ablation (RFA) uses heat energy produced by high-frequency electrical currents.
  • Microwave ablation sends microwaves through the needle to create heat.
  • Cryoablation uses a substance such as liquid nitrogen to generate intense cold.

At OHSU, we recommend ablation for patients who have one or a few small tumors. In many cases, ablation can eliminate small liver tumors or provide a bridge to a liver transplant.

Embolization

Embolization blocks the blood supply to cancer cells to shrink or eliminate tumors. 

The liver has two blood supplies:

  • The portal vein
  • The hepatic artery

Most normal cells receive blood from the portal vein. Cancer cells, though, tend to receive blood from the hepatic artery. So blocking the hepatic artery can starve cancer cells while protecting most normal liver tissue.

We might recommend embolization for patients who:

  • Have several liver tumors.
  • Have a large tumor that cannot be removed with surgery.
  • Are waiting for a liver transplant.

Types of embolization include:

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.

Also known as transarterial chemoembolization, or TACE, this treatment combines cancer-fighting medications (chemotherapy) with embolization. Your doctor uses a catheter to inject tiny beads containing chemotherapy. TACE delivers chemotherapy directly to liver tumors while also blocking their blood supply.

This treatment combines embolization with radiation therapy. Your doctor uses a catheter to place tiny beads that contain a radioactive material, yttrium-90. The beads block blood supply and also deliver radiation therapy directly to tumors. 

Watch a patient education video about radioembolization at OHSU.

Chemotherapy and hepatic arterial infusion

Traditional chemotherapy is a “systemic” treatment. That means medications travel through the bloodstream to nearly all parts of the body to destroy cancer cells. Standard chemotherapy medications haven’t been effective in treating liver cancer, but new approaches are showing promise in clinical trials. 

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

  • How it works: Your care team implants a pump under the skin of your belly and connects it to the hepatic artery with a thin tube. The pump delivers concentrated chemotherapy directly to liver tumors. This harms fewer healthy cells and causes fewer side effects than standard chemotherapy.
  • Advantages: Hepatic arterial infusion 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

As an academic health center, OHSU continually studies 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. For example, our research includes the use of targeted therapy and new treatments for bile duct cancer. 

Additional services

At OHSU, we provide many services to help you and your family, including: 

  • Cancer rehabilitation services: Our highly trained physical and occupational therapists can help you regain strength and function as part of your cancer care plan.
  • Palliative care: Our expert Palliative Care Service team offers expertise in cancer. Our providers can help you and your family manage symptoms and anxiety at any stage of a serious illness.
  • Cancer social workers: Our cancer social workers have specialized training to 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: OHSU’s cancer registries, including one for liver tumors, help researchers unlock better ways to detect and treat disease. OHSU also offers a registry for patients who have had part of their liver removed. Learn how you can participate.

Learn more

For patients

Call 503-418-9500 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.W. Bond Ave.
Portland, OR 97239

Map and directions

Refer a patient

Read more

Learn more about OHSU Knight Cancer Institute treatments: