How is Liver Cancer Treated?

This is the eighth page in the Understanding Liver Cancer Guide. This guide was developed by the HealthTree Education Team and was last updated and reviewed on June 20, 2026.

The treatment for liver cancer depends on several factors, including the number and size of tumors, whether the cancer has spread, how well the liver is functioning, and your overall health. Many people with liver cancer also have underlying liver disease such as cirrhosis, which affects which treatments are safe and possible. Treatment is best planned by a multidisciplinary team of specialists that includes a hepatologist, a surgical oncologist or liver transplant surgeon, a medical oncologist, an interventional radiologist, and a radiation oncologist.

Getting a second opinion from an experienced liver cancer team, especially one at a major cancer center or transplant program, is normal and often very helpful.

Surgery

Partial hepatectomy

A partial hepatectomy is an operation to remove the part of the liver that contains the cancer. It can be curative for patients with early-stage liver cancer whose liver function is well preserved and who have enough healthy liver tissue remaining after the surgery. Because the liver can regenerate, it is sometimes possible to remove a large portion of the liver safely. However, partial hepatectomy is not an option for patients whose liver function is too reduced by cirrhosis.

Liver transplantation

For selected patients, liver transplantation offers the best chance of cure. It removes not only the cancer but also the underlying diseased liver, eliminating the conditions that caused the cancer in the first place. Transplantation is most appropriate for patients who meet the Milan Criteria: a single tumor up to 5 centimeters, or up to three tumors each no larger than 3 centimeters, with no spread to blood vessels or outside the liver. Patients must wait for a suitable donor liver to become available. During the wait, treatments such as ablation and embolization are often used to keep the cancer from growing.

Ablation

Ablation treatments destroy liver tumors without removing them. They are most effective for small tumors and for patients who cannot have surgery.

• Radiofrequency ablation. A thin needle is inserted into the tumor, usually through the skin under imaging guidance. Electrical energy heats the needle tip, destroying the tumor with heat. Radiofrequency ablation is effective for tumors smaller than 3 to 4 centimeters.
• Microwave ablation. Similar to radiofrequency ablation but uses microwave energy to generate heat. It can be more effective for larger tumors and tumors near blood vessels.
• Cryoablation. Uses extreme cold to destroy tumor cells. Less commonly used for liver tumors than heat-based techniques.
• Percutaneous ethanol injection. A concentrated alcohol solution is injected directly into the tumor to destroy cancer cells. It is less commonly used now that radiofrequency ablation is widely available.

Embolization

Embolization procedures block the blood supply to liver tumors. Because hepatocellular carcinoma tumors are fed primarily by the hepatic artery, blocking that blood supply can kill the tumor cells while the rest of the liver continues to receive blood through the portal vein.

• Transarterial chemoembolization, known as TACE. A thin tube called a catheter is inserted through an artery in the groin and guided to the hepatic artery branches that feed the tumor. A mixture of chemotherapy drugs and particles that block blood flow is injected directly into those vessels. This delivers a high dose of chemotherapy directly to the tumor while also cutting off its blood supply. TACE is the most commonly used treatment for intermediate-stage hepatocellular carcinoma.
• Transarterial radioembolization, known as TARE or SIRT. Similar to TACE but uses tiny beads loaded with a radioactive substance called yttrium-90 instead of chemotherapy. The beads travel through the blood vessels into the tumor and deliver radiation from inside. TARE is used for selected patients with larger tumors or those near blood vessels.
• Bland embolization. Blocks blood vessels feeding the tumor without chemotherapy or radiation. Less commonly used as TACE and TARE are generally preferred.

Radiation therapy

• Stereotactic body radiation therapy. A specialized form of radiation therapy that delivers very high, precisely targeted doses of radiation to liver tumors in a small number of treatment sessions, usually three to five. It is effective for tumors that cannot be treated with surgery or ablation, and it is increasingly used as an alternative to TACE for some patients.
• External beam radiation therapy. Standard external beam radiation is generally not used for liver cancer because the liver is sensitive to radiation, and the doses needed to treat a tumor may damage too much healthy liver tissue. When it is used, modern techniques that minimize radiation to healthy liver tissue are employed.
• Proton beam therapy. A specialized form of radiation that uses protons instead of X-rays. It allows more precise targeting and may reduce dose to the healthy liver. It is available at specialized centers and is being studied in clinical trials.

Systemic therapy: targeted therapy

Targeted therapies are drugs that attack specific proteins or pathways in cancer cells that help them grow. They are used primarily for advanced hepatocellular carcinoma and for intrahepatic cholangiocarcinoma.

Targeted therapies for hepatocellular carcinoma

• Sorafenib. The first targeted therapy approved for advanced hepatocellular carcinoma, sorafenib works by blocking proteins that help tumors grow new blood vessels and multiply. It remains an important option for patients who do not respond to or are not candidates for immunotherapy.
• Lenvatinib. Another targeted therapy that blocks blood vessel growth and tumor cell signaling. It is approved as a first-line treatment for advanced hepatocellular carcinoma and has shown results comparable to sorafenib.
• Regorafenib. A targeted therapy approved for patients with advanced hepatocellular carcinoma who have already been treated with sorafenib.
• Cabozantinib. A targeted therapy approved for patients with advanced hepatocellular carcinoma who have received prior treatment.
• Ramucirumab. A targeted therapy that blocks a protein called VEGFR-2, used for patients with high AFP levels who have received prior treatment with sorafenib.

Targeted therapies for intrahepatic cholangiocarcinoma

• Infigratinib, pemigatinib, and futibatinib. FGFR inhibitors that target FGFR2 gene fusions or rearrangements found in some intrahepatic cholangiocarcinomas. These drugs are approved for patients who have been previously treated with chemotherapy.
• Ivosidenib. An IDH1 inhibitor approved for intrahepatic cholangiocarcinomas with IDH1 mutations in previously treated patients.

Systemic therapy: immunotherapy

Immunotherapy has become a central part of treatment for advanced liver cancer. These drugs work by removing the brakes that cancer puts on the immune system, allowing the immune system to attack the cancer.

• Atezolizumab plus bevacizumab. This combination of a PD-L1 checkpoint inhibitor and an anti-VEGF targeted therapy is currently the preferred first-line treatment for advanced hepatocellular carcinoma in patients with good liver function. Studies have shown it improves survival compared to sorafenib alone.
• Durvalumab plus tremelimumab. A combination of two checkpoint inhibitors, one blocking PD-L1 and one blocking CTLA-4, approved for advanced hepatocellular carcinoma.
• Pembrolizumab. A PD-1 checkpoint inhibitor approved for previously treated advanced hepatocellular carcinoma. It is also approved for any solid tumor, including liver cancer, that is mismatch repair deficient or microsatellite instability-high.
• Nivolumab and ipilimumab. A combination of PD-1 and CTLA-4 checkpoint inhibitors approved for previously treated advanced hepatocellular carcinoma.
• Gemcitabine plus cisplatin plus durvalumab. A chemotherapy and immunotherapy combination approved as first-line treatment for advanced biliary tract cancers, including intrahepatic cholangiocarcinoma.

Chemotherapy

Traditional chemotherapy has a limited role in hepatocellular carcinoma because the liver metabolizes most chemotherapy drugs, and liver function is often already compromised. Chemotherapy is more commonly used for intrahepatic cholangiocarcinoma. The standard first-line regimen for biliary tract cancers, including intrahepatic cholangiocarcinoma, is gemcitabine combined with cisplatin, often now with durvalumab added.

Supportive and palliative care for liver cancer

Treating the symptoms of cancer and the side effects of treatment is called supportive and palliative care. This is an important part of cancer care at every stage. Supportive care can include:

• Pain management
• Management of ascites, the buildup of fluid in the abdomen, through dietary changes, medications, and periodic drainage procedures
• Management of hepatic encephalopathy, confusion caused by reduced liver function
• Nutritional support, including working with a registered dietitian who understands liver disease
• Management of treatment-related side effects such as fatigue, nausea, high blood pressure from anti-VEGF therapies, and skin reactions
• Mental health support and counseling

There is a common misconception that palliative care is only given at the end of life. Palliative and supportive care can be given at any time during cancer treatment to improve comfort and quality of life.

Follow-up care after treatment

After liver cancer treatment, regular follow-up is essential. Follow-up visits help detect signs of recurrence or new tumors early, monitor liver function, and support recovery. Follow-up typically includes blood tests such as AFP levels, imaging with CT or MRI, and liver function testing. Appointments are usually more frequent in the first two years after treatment, when recurrence is most likely, and continue at decreasing intervals for at least five years.