Surgical Procedures: Surgery and Staging for Liver Cancer

When there are cancer cells in your liver, it is called liver cancer. Cancer that started in the liver is called primary liver cancer. Most cancers found in the liver have spread there from somewhere else in the body, called metastases. This article will talk about surgeries for primary liver cancer.

The liver is found in the upper right part of the belly and has four separate lobes (parts). The jobs of the liver are to:

• Filter waste and harmful toxins from the blood.
• Make bile.
• Help with blood clotting.
• Store sugar to be used for energy.

Often, adults with primary liver cancer have a type called hepatocellular carcinoma. Other cancers found in the liver are hepatoblastoma (most common in children) and cancer of the bile duct, which is called cholangiocarcinoma.

What is staging and how is it done?

Staging is a way to find out how, if, and where cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include:

Physical Exam: This is a general exam to look at your body and to talk about your past health issues.

Imaging: Radiology tests can look inside your body at the cancer and see if it has spread. These tests can include:

• CAT scan (CT scan).
• Magnetic Resonance Imaging (MRI).
• Positron emission tomography (PET Scan).
• Angiogram/Ultrasound.

Laboratory Tests: Certain blood tests may be done, including liver function tests (LFTs) and tumor markers, such as alpha-fetoprotein (AFP) levels.

Procedures: Each case of liver cancer is different. Talk with your care team about which procedures may be part of your treatment plan. These options may include:

• Biopsy: A biopsy takes cells from the cancer to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope in a laboratory.
  • Fine-needle aspiration (FNA): A thin needle is inserted into the liver to remove (aspirate) tissue or fluid for testing.
  • Core needle biopsy: A wider needle is inserted into the liver to remove tissue or cells.
  • Laparoscopy: Many small incisions (cuts) are made in the belly. The surgeon will place a laparoscope (thin, lighted tube) with tools on the end of it into the belly.

Staging looks at the size of the tumor and where it is, and if it has spread to other organs. It also helps figure out what treatment is best. Liver cancer in adults may be staged using the Barcelona Clinic Liver Cancer Staging System (BCLC staging system), which stages the cancer as:

• Stage 0: Very early.
• Stage A: Early.
• Stage B: Immediate.
• Stage C: Advanced.
• Stage D: End-stage.

Liver cancer may also be staged using the AJCC staging system, which uses a numerical system of I through IV.

Often, liver cancer is treated with surgery.

Surgical Procedures for Liver Cancer

There are two common surgeries used to treat liver cancer:

• Partial Hepatectomy: Part of the liver is removed, as well as some of the nearby normal tissue. At times, the liver may regenerate or regrow the missing part.
• Liver Transplant: The whole liver is removed and a liver from a donor will replace the diseased one.

What are the risks associated with liver cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Bleeding.
• Blood clots.
• Infection.

If you have a liver transplant, you will have to take anti-rejection medications to make sure that your body accepts the new liver. Taking anti-rejection medications suppresses the immune system, which can lead to:

• Serious infections.
• High blood pressure.
• High cholesterol.
• Diabetes.
• Weak bones and kidneys.
• Metastatic liver cancer (liver cancer that has spread somewhere else in the body) and/or a secondary (new) cancer.

Before surgery, your care team will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from liver cancer surgery is based on the type of procedure you have had. For those who have had a partial hepatectomy, a hospital stay is often needed. Transplant recipients should ask their providers how long they will need to be in the hospital.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention, organ anti-rejection and/or other conditions.

Common changes to activity level and postoperative instructions for a liver resection are to:

• Take medications as prescribed.
• Avoid tub bathing.
• Take stool softeners and laxatives as told, increase fluid intake, and avoid foods that make you constipated.
• Do not drive while taking narcotic pain medications.
• Avoid heavy lifting.

Transplant patients may have other post-operative instructions and should speak with their healthcare team.

Contact your healthcare team if you have:

• Fever. Your team will tell you at what temperature they should be called.
• Any new or worsening pain.
• Redness, swelling and/or drainage at the incision.
• Nausea, vomiting, diarrhea, or constipation. Speak with your healthcare team if you have not had a bowel movement in 3 days or more.
• Yellowing of the skin or eyes (jaundice).

If you have had a transplant, your team will continue to check for organ rejection through blood tests and, at times, liver biopsies.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.