Liver-directed treatment for cancer that has spread to the liver | CION Cancer Clinics

Liver-directed treatment means treating cancer spots in the liver directly, instead of only with medicines that travel through the whole body. It includes surgery, ablation, TACE, Y-90 radioembolisation and focused radiation called SBRT.

Who this page is for

This page is about secondary liver cancer: cancer that started somewhere else, such as the breast, bowel, pancreas or eye, and spread to the liver. If the cancer started in the liver itself, the same procedures are used in a different way, and the comparison for primary liver cancer is the better place to start.

Where it fits in the plan

For most secondary cancers, medicines such as chemotherapy, targeted therapy or immunotherapy come first, because cancer in the liver usually means cancer cells are in the blood as well. Liver-directed treatment is added for selected people, usually when the spread is limited and mostly in the liver. It is rarely the whole answer on its own. Bowel cancer is the main exception, and it has its own detailed pages on the colon cancer section.

It usually does not suit people whose cancer has spread widely outside the liver. Treating the liver alone would leave the rest untouched, and the procedure would add risk without much gain. Medicines are the better tool in that case.

When the liver itself is struggling

If the liver is already weak, with jaundice, fluid in the abdomen or a large share of the liver replaced by tumour, TACE, Y-90 and surgery can tip it into failure. The team may advise against them for safety. The page on liver function when the liver is full of metastases explains this.

When the cancer is still growing on treatment

If new spots keep appearing while on medicines, treating the ones you can see rarely helps. The cancer is showing it can grow faster than local treatment can keep up.

When you are not fit enough

Serious heart, lung or kidney illness, or being unable to manage daily life without help, can make a procedure unsafe. Saying no to a procedure in these situations protects you. It is not giving up.

It cannot tell you whether a procedure is right for your liver spots. That depends on the cancer type, the number and position of the spots, the response to medicines and the strength of your liver. Only a team looking at your own scans can weigh those together.

Where the evidence is thin

For bowel cancer and some neuroendocrine tumours, the case for treating the liver is well studied. For many other cancers, including breast, stomach and pancreatic cancer, the studies are smaller and doctors disagree. A careful team will tell you when the benefit is uncertain.

What this page does not cover

It does not explain how each procedure is done or what it costs. Those details are on the TACE and SBRT pages. It also cannot tell you how long anyone will live. Ask your own oncologist that question directly.