Liver Cancer Treatment

About Liver Cancer

At Penn Medicine, patients with liver cancer, or hepatocellular carcinoma (HCC), receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

The Abramson Cancer Center's interdisciplinary gastrointestinal cancer program was the first of its kind. Its close collaboration with Penn Medicine's transplant program provides access to comprehensive medical and surgical care for patients who require a liver transplant. Penn Transplant Institute has performed more than 1,500 liver transplants.

The liver is the largest solid organ in the body and is located on the right side of the abdomen. The liver is responsible for such functions as filtering the blood for excess toxins, helping regulate blood sugar, creating bile for digestion, and creating enzymes responsible for blood clotting.

There are two main types of liver cancer.

  • Primary liver cancer: Cancer that forms in the tissues of the liver. The most common type is hepatocellular carcinoma (HCC).
  • Secondary liver cancer: Cancer that spreads, or metastasizes, to the liver from another part of the body like the breast, lung, thyroid or other gastrointestinal cancers.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Liver Cancer

Diagnosing Liver Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options to treat liver cancer.

Patients who choose Penn's Abramson Cancer Center, benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan designed specifically for each patient with liver cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing cancer and are actively researching better and more precise ways to detect liver cancer.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine's contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Liver Cancer

Liver Cancer Treatment

Following the diagnosis and staging of liver cancer, cancer specialists at Penn's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for liver cancer include:

  • Surgery
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation therapy (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
    • Stereotactic body radiotherapy
  • Chemotherapy
    • Liver-directed therapies
      • Ethanol injection
      • Chemoembolization of the hepatic artery
  • Biologic therapies
  • Other treatments

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Surgery for Liver Cancer

Penn Medicine has one of the largest gastrointestinal surgical programs in the United States with a nationally recognized record for high-quality patient care and long-term survival.

Partial Hepatectomy

A partial hepatectomy removes the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.

Hepatic Lobectomy

A hepatic lobectomy is the surgical removal of a lobe of the liver. The remaining liver tissue takes over the functions of the liver.

Radiofrequency Ablation

Radiofrequency ablation uses a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital using general anesthesia.

Total Hepatectomy and Liver Transplant

A total hepatectomy and liver transplant removes the entire liver and replaces it with a healthy donated liver. A liver transplant may be done when the cancer is only in the liver and a donor liver is available. If the patient has to wait for a donated liver, other treatment is given as needed.

Liver cancer patients who are candidates for liver transplant benefit from a close collaboration between their physicians within the gastrointestinal cancer program and Penn Medicine’s transplant program. The Penn Transplant Institute provides comprehensive medical and surgical care for patients who require a liver transplant.

Penn Medicine has performed more than 1,500 liver transplants.
The Penn Transplant Institute has an active Living Donor program for patients requiring a liver transplant. The anatomy of the liver allows it to be divided and a portion transplanted into another individual. Using a family member or another person as a source for liver transplantation benefits donors by reducing the waiting time for a transplant and improves the chances of organ survival.

Radiation Therapy for Liver Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.

Proton therapy at Penn Medicine will soon be used to treat liver cancer, and is currently used to treat recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.

3-D Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Conformal radiation therapy gives doctors more control when treating tumors.

Special computers use CT imaging scans to create 3-D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-Modulated Radiation Therapy (IMRT)

This advanced type of radiotherapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor. The therapy allows higher radiation doses to be delivered to regions within the tumor while minimizing the dose to the surrounding area.

Volumetric-Modulated Arc Therapy (VMAT)

Volumetric modulated arc therapy (VMAT) is a type of specialized intensity modulated radiation therapy. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patient more comfort because it does not require patients to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only academic medical center in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat liver cancer, one of the only health care centers in the country to do so.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Stereotactic Body Radiotherapy

Stereotactic body radiotherapy is a type of stereotactic radiosurgery that uses a linear accelerator to deliver high doses of radiation to a targeted area over a shorter length of time. The precision of stereotactic body radiotherapy allows Penn radiation oncologists to target small tumors, or tumors that are difficult to reach.

Chemotherapy for Liver Cancer

Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to surgery. Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body.

Liver-directed Therapies

Ethanol Injection
A high concentration of ethanol injected directly into tumor cells can kill the tumor. Only small tumors can be treated in the manner. For patients with a several small tumors, ethanol injections can result in reasonable rates of tumor control.

Chemoembolization of the Hepatic Artery
Injecting an anticancer drug into the hepatic artery that supplies blood to the liver blocks blood flow to the liver and interrupts the blood supply to the tumor.

Biologic Therapies

Tyrosine kinase inhibitors (TKIs) such as sorafenib, may be effective in treating hepatocellular carcinoma by inhibiting tumor-cell proliferation and tumor angiogenesis. Tyrosine kinase is a chemical messenger (enzyme) that plays a part in the growth of cancer cells. Biologic therapies are available as clinical trials.

Clinical Trials for Liver Cancer

Clinical trials benefit patients by introducing breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Currently, patients with liver cancer may be candidates for these clinical trials at Penn Medicine:

  • Biologic therapy. Biologic therapy uses the patient's own immune system to fight cancer. Substances made by the body or in a laboratory are used to boost, direct or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
  • Hyperthermia therapy. Hyperthermia therapy exposes the cancer tissue to high temperatures that damage and kill cancer cells, or makes cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells, the cancer cells die and the tumor shrinks.
  • Proton therapy. Penn Medicine is the academic medical center in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat gastrointestinal cancers in the upper digestive tract. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat liver cancer, the only health care center in the country to do so.

Find more liver cancer clinical trials at Penn Medicine.

Other Treatments for Liver Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Care Clinic helps to manage cancer related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or to improve quality of life when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end of life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Patient navigation Specialists

Every step of cancer treatment – from a cancer diagnosis, to surgery and treatment to forming a survivorship plan – comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, patient navigation specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Oncology Navigation Specialists at the Abramson Cancer Center.

Liver Cancer Survivorship

There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete. Survivorship programs at Penn Medicine are a distinct phase of liver cancer care and are designed to help patients transition from their cancer treatment routine to a post-cancer care lifestyle.

Read more Liver Cancer Survivorship


Perry Rothaus

A fifteen-year cancer survivor, Perry Rothaus feels that not enough attention is given to caregivers, and he credits his wife, Judi, with his survival. Judi researched his type of cancer, decided on the Abramson Cancer Center for his care, and and a

Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more

Clinical Trials

Liver Cancer Trials

Phase III Randomized Trial of the Role of Whole Brain Radiation Therapy in Addition to Radiosurgery... more