The ideal therapy for a localised hepatocellular carcinoma is complete surgical resection. If the patient is in otherwise good health and non-cirrhotic, the liver function is not greatly disturbed and the cancer is confined to one lobe of the liver then the operation should be well tolerated and has a reasonable chance of cure.
However, too often the patient is cirrhotic, has deranged liver function and a large tumour of borderline operability, then the operative mortality can rise to 10% and the chance of ultimate cure becomes small.
The practice of liver transplantation has become unfashionable due to the high incidence of late metastatic relapses.
For inoperable tumours, and in patients whose condition merits further therapy – given that it will not cure and has toxicity of its own, then chemotherapy is considered. This is usually given intravenously but intra-arterial chemotherapy (into the hepatic artery) delivers a high concentration to the tumour and has its advocates. It can be combined with an embolisation procedure to both block the artery supplying blood to the tumour and target it with cytotoxic chemotherapy.
Embolisation (plugging of an artery) of the hepatic artery is particularly useful for painful hepatocellular carcinoma, distending the liver. The chemoresponsiveness of hepatocellular carcinoma is not great but the drug doxorubicin (also called adriamycin) is the most validated.
