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 may begin in the liver (primary). More commonly, it spreads to the liver from another area of the body (secondary). 

Your treatment depends on the type and severity of the cancer. Once we learn all we can about your liver cancer, we’ll recommend a treatment plan that’s right for you.

The most common treatment for early-stage liver cancer is surgery. Additional treatment options are:  

  • Tumor ablation
  • Embolization therapy
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy

We know cancer diagnosis can be overwhelming. We’re here to give you the best care available. We’ll also provide you and your loved ones with the support you need throughout your treatment.

Additional References:

Surgery

We may perform surgery to remove early stage liver cancer if you have good liver function. 

Partial hepatectomy surgery removes the tumor and some surrounding healthy tissue. The amount of liver removed depends on the number, size, and location of the tumor.

The remaining liver takes over functioning for the entire liver. The liver is the only internal organ capable of growing back (regenerating) lost tissue. It takes a few weeks to return to normal size.

Liver transplantation surgery removes the entire liver (total hepatectomy). The liver is replaced with healthy liver tissue from a donor. If the donor is:

  • Deceased, you receive a whole liver.
  • Living, you receive part of the liver. 

Living donor transplants are extremely rare. There are also few livers available from deceased donors. You may have other treatment while waiting for a new liver.

Surgery Side Effects

Liver surgery is a major operation, and recovery takes time. Your hospital stay depends on the extent of surgery and if you have any complications.

Possible side effects of partial hepatectomy include:

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

Another concern is that the abnormal tissue in the tumor isn’t completely removed during surgery. This may cause a new liver cancer to form.

For a liver transplant, possible side effects are:

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

Drugs help suppress your immune system to prevent your body from rejecting the new liver tissue. Possible side effects of these drugs are: 

  • High risk of infection
  • High blood pressure
  • High cholesterol
  • Facial puffiness

We monitor you closely for side effects to immediately treat any problems.

Tumor Ablation

We may recommend treatment to destroy the tumor without removing it (ablation) when the tumors are small or can’t be removed with surgery.

Radiofrequency ablation uses heat to burn the tumor. We insert a thin probe through the skin and into the tumor. Radio waves pass through the probe to heat and destroy the tumor.

Cryosurgery (or cryotherapy) destroys the liver tumor by freezing it. We insert a metal probe through the skin and into the tumor. Extremely cold gases pass through the probe to freeze and destroy the tumor. 

Chemoablation injects a chemical substance directly into the tumor to kill cancer cells.

Side effects

Ablation rarely causes serious complications, but possible side effects are: 

  • Fever
  • Abdominal pain
  • 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 blood supply to the tumor. Without nutrients and oxygen, the cancer cells die. It doesn’t affect blood flow to normal liver cells.

We may recommend this treatment if your tumors:

  • Can’t be removed with surgery. 
  • Are too big for ablation (larger than 5 centimeters).
  • Are 3 to 5 centimeters and being treated with ablation.

Arterial embolization. We thread a tiny tube into an artery in the liver and inject small particles to block blood supply.

Chemoembolization. We inject a chemotherapy drug and small particles into the artery. The chemotherapy remains in your liver longer.

Radioembolization. We inject small radioactive beads into the artery. The beads become wedged in blood vessels close to the tumor and kill cancer cells.

Side effects

Possible side effects include:

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

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. 

  • Radioembolization delivers radiation inside the body. 
  • External-beam radiation delivers radiation outside the body.

We use targeted radiation techniques to avoid harming healthy liver and surrounding tissue, such as:

  • 3D-CRT (three-dimensional conformal radiation therapy). A CT scan identifies the tumor location. Small doses of radiation are given 5 days a week for several weeks.
  • Stereotactic radiosurgery. Special computers pinpoint the exact tumor location. Large doses of radiation are given for 1 to 5 days. 

Despite its name, surgery isn’t used with the stereotactic radiosurgery procedure. It may be used more than once. 

Side effects

Possible side effects are:

  • Skin changes, such as redness
  • Nausea and vomiting
  • Fatigue
  • Diarrhea

Radiation therapy may worsen chemotherapy side effects when given at the same time. Symptoms usually go away after treatment ends. We can help manage side effects.

Additional References:

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. However, liver cancer cells often don’t respond well to traditional chemotherapy. 

Instead, we may deliver chemotherapy directly to the tumor inside the body (hepatic artery infusion). It blocks blood supply to the tumor, so the cancer cells die.

Side effects

Traditional chemotherapy can cause: 

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

Hepatic artery infusion causes fewer side effects. The liver breaks down most of the chemotherapy drugs before it reaches other parts of the body.

When chemotherapy drugs travel to the gallbladder, possible side effects are infection and inflammation.

Additional References:

Targeted Therapy

Targeted therapy delivers drugs that attack specific parts of cancer cells.

For advanced liver cancer, it slows down growth of the tumor and blocks its blood supply. By cutting off its food supply, targeted therapy essentially starves the tumor.

Side effects

Because targeted drugs identify and attack specific cancer cells, there’s less damage to healthy cells. Side effects may include: 

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

We will watch you closely for side effects. Let us know as soon as you notice symptoms so we can manage them.

Clinical Trials

We’re always looking for new and better ways to treat liver cancer. Clinical trials are research studies that test new treatments and procedures. We can talk about available clinical trials that 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.

Related Health Tools:

Podcasts

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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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