Medical Oncologist
CION Cancer Clinics
Surgery, transplant, ablation, TACE or tablets: a plain comparison | CION Cancer Clinics
Surgery, transplant and ablation aim to remove or destroy a small liver cancer completely. TACE, radiation and tablets or infusions aim to control cancer that is larger, multiple or spread. Which one suits you depends on the tumour, and just as much on how well your liver works. This page sets the main options side by side and explains how a team chooses between them. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- Which liver cancer treatment is right for which person?
- What does each treatment do, and who is it usually for?
- What does the team weigh before choosing?
- How does a comparison become a decision?
- What do families often get wrong about these choices?
- When does this comparison not apply to you?
- What can this page not tell you?
- Common questions about comparing liver cancer treatments
The short answer
Which liver cancer treatment is right for which person?
Surgery, transplant and ablation aim to remove or destroy the cancer completely, and they suit a small tumour in a liver that still works well. TACE, radiation and tablets or infusions aim to control the cancer, and they suit larger, multiple or spread tumours, or a liver that is too weak for an operation.
Why the liver decides as much as the tumour
In most cancers, the size and spread of the tumour pick the treatment. Liver cancer is different. Most people with hepatocellular carcinoma (HCC, cancer that starts in the liver cells) also have cirrhosis, which means long-term scarring of the liver. Every treatment takes something from the liver. A treatment that suits the tumour can still be unsafe if the liver underneath cannot cope with it.
Which liver cancer this page is about
This page is about primary liver cancer, mainly HCC. If a scan showed cancer that spread to the liver from the bowel, breast or elsewhere, the plan is built around that first cancer. Read about the difference between primary and secondary liver cancer before comparing anything here.
Most people need more than one of these treatments over time. The comparison is a starting point, not a menu.Side by side
What does each treatment do, and who is it usually for?
Treatment
Usually considered when
Liver resection: the surgeon removes the part of the liver holding the tumour
One tumour, a liver with little or no cirrhosis, normal pressure in the liver's veins, and enough healthy liver left behind
Liver transplant: the whole diseased liver is replaced
Small, limited cancer inside a badly scarred liver, within agreed size and number limits, and fit for a major operation
Ablation: a needle passed through the skin heats and destroys the tumour
A small tumour, or a few, in a position the needle can reach safely, often when surgery is too risky
TACE: chemotherapy and blocking particles sent down the tumour's own artery
Several tumours or a larger one confined to the liver, with reasonable liver function and no major vein blocked
TARE or Y-90: tiny radioactive beads sent the same way
Similar situations to TACE, and some cases where cancer has grown into a vein
SBRT: a few sessions of highly focused radiation
A small tumour that cannot be removed or ablated, or one left after other treatment
Systemic treatment: immunotherapy or targeted tablets through the bloodstream
Cancer in a major vein or outside the liver, or growing despite local treatment
Not sure whether this applies to you?
Ask an oncologistHow the team decides
What does the team weigh before choosing?
Four questions come up at every tumour board meeting for liver cancer. The answer to all four together picks the treatment.
The tumour
How many tumours there are, how large, and whether any has grown into the portal vein, the main vein carrying blood into the liver. Spread outside the liver changes the plan from local treatment to whole-body treatment.
The liver
Blood tests such as bilirubin (the yellow pigment that causes jaundice), albumin (a protein the liver makes) and INR (how well blood clots), plus any fluid in the abdomen or confusion. These feed into the Child-Pugh score.
A well-working liver keeps every door open. A failing liver closes most of them.The person
How active you are day to day, your heart and lungs, diabetes, kidney function and muscle strength. A major operation needs a body that can recover from it.
Where the tumour sits
A tumour beside a large blood vessel, the bile ducts, the heart or the bowel can rule out a needle or make an operation bigger than it first looks.
From scan to plan
How does a comparison become a decision?
The right scan
A triple-phase CT or an MRI of the liver shows how many tumours there are and how they behave. CION arranges these through accredited diagnostic partners.
The liver check
Blood tests, and sometimes an endoscopy or a liver stiffness scan, show how much reserve the liver has and whether pressure in its veins is raised.
The tumour board
Surgeons, oncologists, radiologists and liver specialists look at the same scans together. Each option is matched against your tumour, your liver and your fitness.
The plan, and a back-up plan
You hear the first choice, the reason for it, and what happens next if it does not work. TACE, ablation, radiation, surgery and transplant are carried out at accredited partner hospitals, and your team will tell you where.
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Commonly believed
What do families often get wrong about these choices?
"Surgery is always the strongest option, so we should push for it."
An operation on a liver that cannot cope can cause liver failure. For a small tumour in a scarred liver, ablation or transplant is often the safer route to the same aim.
"TACE is only for people who have run out of options."
For cancer confined to the liver but too large or too many for surgery, TACE is a standard first treatment. It is also used to keep a tumour in check while someone waits for a transplant.
"Tablets and injections mean the doctors have given up."
Systemic treatment is the right treatment when cancer has reached a vein or another organ. Read about why advanced does not mean untreatable.
"Once you pick one treatment, the others are closed."
Treatments are often combined or used one after another. A tumour can sometimes be shrunk with TACE until surgery or a transplant becomes possible.
Who this does not suit
When does this comparison not apply to you?
The table above describes HCC in adults. It does not fit several groups, and using it would mislead them.
Cancer that spread to the liver
If the liver tumours came from bowel cancer, the decisions belong to the colon cancer team, and surgery is used far more often. Other secondary cancers are usually treated through the first cancer.
Bile duct cancer and children
Cholangiocarcinoma, cancer of the bile ducts inside the liver, is treated differently, with DNA testing of the tumour and different drugs. Liver cancer in children, called hepatoblastoma, has its own pathway.
A liver that is failing
When jaundice, fluid or confusion show the liver is very weak, most cancer treatments do more harm than good. Transplant may still be discussed for a few people. For the rest, symptom care and support become the main treatment.
Being straight with you
What can this page not tell you?
It cannot tell you which treatment you should have. That depends on your scans, your blood tests and an examination, read together by people who treat liver cancer every week. Two people with tumours of the same size can be offered different treatments because their livers are different.
It cannot predict how a treatment will go for you
No comparison table can say how long a treatment will work or what your outlook is. Ask your oncologist what the aim of the recommended treatment is, whether it is meant to remove the cancer or control it, and what happens if it does not work.
If you have been offered one option and want another team to look, a second opinion is a normal request.Questions we are asked
Common questions about comparing liver cancer treatments
Is surgery better than ablation for a small liver cancer?
For a very small tumour in a good position, the two can lead to similar results, and ablation is a smaller procedure. Surgery may be preferred when the tumour is larger, close to a major vessel, or the liver is healthy enough to recover well. Your surgeon and radiologist will compare the two for your scan.
Why was I offered TACE and not surgery?
Usually because there are several tumours, because the tumour is too large to remove safely, or because cirrhosis means removing liver could tip it into failure. TACE treats tumours across the liver without taking healthy liver away. Ask whether surgery might become possible later if the tumours shrink.
Who decides whether I can have a transplant?
A licensed transplant centre decides, after its own assessment of the cancer, the liver and your overall health. CION can help gather your reports and refer you, but cannot influence the waiting list. Read who is eligible on our transplant page.
Can TACE and tablets be given together?
Sometimes. Combining TACE with systemic treatment is being used and studied, and your team will explain whether it fits your situation. The decision depends on how the liver handled earlier treatment and on what the tumour is doing.
Where is radiation used in liver cancer?
Focused radiation called SBRT can treat a small tumour that cannot be removed or reached with a needle. It is also used to ease pain from a large tumour. CION coordinates it through partner hospitals; the technique is explained on our SBRT page.
Do immunotherapy and tablets work for everyone?
No. They help many people with advanced HCC, but not everyone responds, and they need a liver that still works reasonably well. People with a very weak liver, or certain autoimmune illnesses, may not be suitable. Your oncologist will check this before starting.
Does every hospital offer all of these treatments?
No. Ablation, TACE, Y-90 and transplant need specialist teams and equipment. That is why a plan made at a tumour board, with access to every option, matters more than which single treatment one department offers.
How do we start if we only have a scan report?
Bring the scan images on a disc or link, the report, and any recent blood tests. The team will check whether the scan is enough to plan from or whether a liver-specific scan is needed first. Call the helpline and someone will tell you what to bring.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Treatment of Liver Cancer, by Stage
- National Cancer Institute — Liver Cancer Treatment
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- Cancer Research UK — Treatment for liver cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How your treatment is chosenThe tumour board decision, step by stepWhich treatments can remove liver cancer completelyThe options with curative intent, and who they suitWhy Child-Pugh decides what treatment you can haveHow liver function opens or closes each optionCombining treatmentsWhy more than one treatment is often used
Talk to us
Not sure why you were offered one treatment and not another?
Send us your scans and blood reports and our team will explain the options that fit your liver and your tumour. One helpline serves every CION centre.