My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Overview

Cancer that occurs in the liver is often referred to as primary liver cancer. The liver is also a common place for cancer to spread because unlike other organs, the liver has 2 blood supplies. In the United States, cancer found in the liver is more often the result of liver metastases (cancer that has come from another part of the body) than primary liver cancer.

After we learn everything we can about your liver cancer and the overall health of your liver, we discuss the treatment options and develop a plan that is right for you. Standard treatment options for liver cancer include surgery, tumor ablation, embolization therapy, radiation therapy, chemotherapy, and targeted therapy.

Additional References:

Surgery

Surgery may be an option if you have early-stage liver cancer and your liver still functions well. There are 2 types of surgery to treat liver cancer:

  • Partial hepatectomy removes the tumor and some of the surrounding healthy liver tissue. The amount of liver removed depends on the number, size, and location of the tumors. The remaining liver takes over the function of the entire liver until it grows back to its normal size over a period of weeks. (The liver is the only internal organ capable of regenerating lost tissue.)
  • Liver transplantation involves removing the entire liver (total hepatectomy) and replacing it with healthy liver tissue from a donor. If the donor is deceased, you receive a whole liver. If the donor is living, you receive only part of the liver. Living donor transplants are extremely rare, and there is limited availability of livers from deceased donors. You may receive other treatments to keep the disease under control while waiting for a new liver.

Surgery Side Effects

Liver surgery is a major operation, and recovery takes time. The length of hospitalization depends on the extent of your surgery and whether you experience any problems related to surgery. Possible side effects of partial hepatectomy include:

  • Pain
  • Weakness and fatigue
  • Bleeding
  • Infections
  • Temporary liver failure

Another concern after partial liver removal is that abnormal tissue that caused the initial tumor to develop may have been left behind. This may cause a new liver cancer to form.

For a liver transplant, the potential side effects and risks include:

  • Pain
  • Bleeding
  • Infections
  • Rejection of the new liver tissue

Drugs are used to help suppress your immune system and prevent your body from rejecting the new liver tissue. These drugs may make you have a higher risk of infection. In addition, these drugs have their own side effects, such as high blood pressure, high cholesterol, and puffiness in the face. We monitor you closely for these and other side effects, and we immediately address any problems that occur.

Tumor Ablation

Ablation refers to treatments used to destroy a tumor without removing it. Usually these methods are used to treat small tumors that cannot be removed with surgery because of poor liver function or other factors. The types of ablation used to treat liver cancer include:

  • Radiofrequency ablation. This treatment uses heat to burn the tumor. We guide a thin probe through the skin and into the tumor. Radio waves then pass through the end of the probe to heat and destroy the tumor.
  • Cryosurgery. This method destroys a liver tumor by freezing it. We guide a metal probe through the skin and into the tumor. Extremely cold gases pass through the end of the probe to freeze and destroy the tumor. This procedure is also called cryotherapy.
  • Chemoablation. A chemical substance, such as ethanol (alcohol) or acetic acid, is injected directly into the tumor to kill cancer cells.
Side effects 

Ablation procedures rarely cause serious complications, but side effects are possible. These include:

  • Fever
  • Pain in the abdomen
  • Liver infection
  • Bleeding into the abdomen or chest cavity

Let us know if you experience any problems after your procedure.

Embolization Therapy

Embolization therapy blocks the blood supply to the tumor. Without nutrients and oxygen from blood to keep the tumor alive and growing, the cancer cells die. Embolization is an option for those whose tumors cannot be removed with surgery. It may be used for tumors that are too large for tumor ablation (larger than 5 centimeters across) or may be used along with ablation treatment for tumors that fall within the 3 to 5 cm range. The types of embolization used to treat liver tumors are:

  • Arterial embolization. We thread a tiny catheter into the hepatic artery in the liver. We then inject small particles into the artery to block blood supply.
  • Chemoembolization. We inject a chemotherapy drug into the hepatic artery through a catheter. Tiny particles are then injected to block the blood supply. This allows the chemotherapy drug to stay in your liver longer.
  • Radioembolization. We inject small radioactive beads (microspheres) into the hepatic artery. The beads become wedged in blood vessels close to the tumor and deliver radiation that kills cancer cells.

Blocking blood flow through the hepatic artery to starve tumor cells does not affect blood flow to normal liver cells. This is because most healthy liver cells are fed through a different vein called the portal vein. We take advantage of the liver's unique dual blood supply to treat liver cancer.

Side effects 

Embolization can cause a variety of side effects. Possible side effects after embolization include:

  • Abdominal pain
  • Fever
  • Nausea or vomiting
  • Liver infection
  • Fatigue
  • Inflammation of the gallbladder
  • Blood clots

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells. Radioembolization is a type of internal radiation therapy that delivers radiation from inside the body. External-beam radiation therapy, on the other hand, delivers radiation from a machine outside the body.

Because normal liver tissue and nearby blood vessels can be easily damaged by radiation, targeted radiation techniques are used to avoid harming healthy parts of the liver. Options for treating liver tumors with radiation therapy include:

  • Three-dimensional conformal radiation therapy (3D-CRT). A CT scan is used to determine the location of the tumor. Multiple radiation beams are then shaped and aimed directly at the tumor from several angles. Small doses of radiation are given 5 days a week for several weeks.
  • Stereotactic radiosurgery. Special computers pinpoint the exact location of the tumor. During the treatment, multiple beams deliver high-dose radiation directly to the tumor from different directions. Large doses of radiation are given for 1-5 days. Despite its name, there is no surgery involved with stereotactic radiosurgery. This treatment may be used 1 or more times.
Side effects 

Although the goal of radiation therapy is to spare healthy tissues as much as possible, some side effects may occur. Possible side effects include:

  • Skin changes, such as redness
  • Nausea
  • Vomiting
  • Fatigue
  • Diarrhea

Radiation therapy may worsen the side effects of chemotherapy if given at the same time. Usually, symptoms go away soon after treatment ends. Until then, we can help manage the side effects of radiation therapy.

Additional References:

Chemotherapy

The use of traditional chemotherapy drugs to treat liver cancer is limited because liver cancer cells are often resistant to chemotherapy’s toxic effects. However, we sometimes use a technique similar to chemoembolization that delivers chemotherapy directly to the tumor by going inside the body.

Known as hepatic artery infusion, this technique uses a catheter to inject chemotherapy into the hepatic artery that supplies blood to the liver.

Side effects 

Traditional chemotherapy drugs that circulate through the entire body can cause a variety of side effects. These include:

  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Diarrhea
  • Fatigue
  • Low blood cell counts or infection

Hepatic artery infusion usually does not cause as many side effects because the liver breaks down most of the chemotherapy drug before it can reach other parts of the body. However, side effects of hepatic artery infusion include infection and inflammation of the gallbladder if chemotherapy travels to the gallbladder from the liver.

Additional References:

Targeted Therapy

Targeted therapy is a relatively new approach to treating cancer. It involves the use of drugs that target specific parts of the cancer cell that help it survive and grow. For advanced liver cancer, a targeted drug works to slow down growth of the tumor and shut down its blood supply. By cutting off its food supply, targeted therapy essentially starves the tumor.

Side effects 

Because targeted drugs take aim specifically at cancer cells, there is less collateral damage to healthy cells. But the targeted drug for liver cancer is not without side effects, which may include:

  • Rash
  • Hand-foot syndrome (pain, swelling, or blisters on the palms of the hands or soles of the feet)
  • Fatigue
  • Diarrhea
  • High blood pressure
  • Loss of appetite

We will watch you closely for these and other side effects. Notify us as soon as you notice symptoms so we can help manage them.

Clinical Trials

We are always looking for new and better ways to treat liver cancer. Clinical trials are research studies that test new treatments or procedures that may prove better than standard treatments. We will talk with you about whether a clinical trial may be right for you.

Additional References:

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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