A diagnosis of liver cancer can leave you and your loved ones feeling uncertain, anxious and overwhelmed. There are important treatment decisions to make, emotional concerns to manage, and insurance and financial paperwork to organize, among other practical concerns.

It is helpful to keep in mind that there are many sources of information and support for people coping with liver cancer. By learning about this diagnosis and its treatment options, communicating with your health care team, and surrounding yourself with a support network, you will be better able to manage liver cancer and experience a better quality of life.

What is Liver Cancer? There are three types of cancers that are found in the liver. The first is metastatic cancer, which is a cancer that has spread from somewhere else, such as the colon, lung or breast. The second is bile duct cancer, which originates in the bile duct, a long tube-like structure that carries bile out from the liver. The type of cancer that originates in liver cells is called hepatocellular carcinoma (HCC), or primary liver cancer. This is the type of cancer discussed in this fact sheet.

How is Liver Cancer Treated? Standard surgery, or hepatectomy, is the surgical removal of the part of the liver affected by cancer. This procedure can only be performed in people who do not have severe liver damage and whose cancer has not spread to the blood vessels of the liver or other parts of the body. For liver cancers that cannot be removed by surgery, there are several non-surgical options:

• Transarterial embolization (TAE) or transarterial chemoembolization (TACE), in which an inactive substance, with or without chemotherapy, is injected directly into the liver tumor to control and kill the cancer cells;

• Radiofrequency ablation (RFA) or cryoablation, which use high- frequency electrical currents to either create heat and destroy the cancer cells or freeze and kill the cancer cells;

• Radiation therapy, which uses high-energy X-rays or other types of radiation to destroy cancer cells or keep them from growing;

• Intensity-modulated radiation therapy (IMRT), a technique that uses advanced computer technologies to map and plan a precise dose of radiation to the liver;

• Radioembolization is a technique used by the radiation specialist to inject small radioactive beads into the main artery of the liver.

What If the Cancer Spreads Beyond the Liver? If the cancer has spread beyond the liver and surgery is not an option, there are two standard treatment options: targeted treatments and chemotherapy. Sorafenib (Nexavar) is the only targeted treatment for liver cancer that is approved by the U.S. Food and Drug Administration (FDA). Sorafenib works by blocking the action of proteins that promote the growth of new blood vessels. These blood vessels carry oxygen, minerals and other nutrients that tumors need to grow. Sorafenib also blocks a protein called RAF kinase, which helps signal cancer cells to grow and multiply.

In treating liver cancer, chemotherapy is not used as commonly as targeted treatments. Targeted treatments are more likely than chemotherapy to spare healthy tissues, but they may still cause side effects. The standard chemotherapy for liver cancer is called FOLFOX, which consists of folinic acid (Leucovorin), fluorouracil (5-FU) and oxaliplatin (Eloxatin).

Clinical trials continue to search for ways to treat liver cancer that does not respond, or no longer responds, to sorafenib. Ongoing studies are combining sorafenib with a number of different treatments, including doxorubicin, a standard chemotherapy.

What Can I Do to Help Manage the Costs of Liver Cancer? If you are struggling with the cost of your treatment, having open conversations with your health care team can help you become better informed about your options and reduce financial cost and stress.

It can be helpful to start by reviewing your insurance policy and asking your provider to assign you a case manager to help you stay organized. You can also keep a diary of your medical expenses, which will help you anticipate and prepare for expenses related to your treatment, and can be useful if you need to dispute a charge. It is important not to delay applying for benefits, as it can take a long time for them to process. Do not ignore your bills, as it is harder to dispute a charge once it goes to a collection agency.

Understanding your insurance policy and staying up-to-date on your bills can help you avoid claim denials (when an insurance provider refuses to pay for a treatment or procedure). Note that many procedures for treating liver cancer must be pre-authorized by your insurance provider, so it’s important to check and make sure you’ve received any necessary authorization before you undergo any procedures.

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This activity is supported by a contribution from Lilly.

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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