In the advanced stages of liver cancer, cancer cells spread to other organs, because of which it cannot be treated with surgery. The lymph nodes may also be affected at this stage.

The treatment options for the advanced stages of liver cancer are:

Tumor ablation
For tumors smaller than 3 cm, ablation can be done. This treatment is used to destroy the tumor without removing the liver. It is a good option for patients who cannot undergo surgery. The different ablation procedures are:

• Thermal ablation: Heat is used to destroy the tumor. The heat may be from radio waves (radiofrequency ablation) or microwaves (microwave ablation). In this procedure, the patient is first sedated through the use of general or local anesthesia. A fine needle is inserted into the liver where the tumor is. A CT scan or an ultrasound scan may be used for guidance in inserting the needle at the right spot. Then, heat waves are sent through the needle. The treatment takes about 1-2 hours. An overnight stay is recommended for observation.
• Alcohol injection: Pure alcohol is injected into the tumor using needles. The surgeon may use scans to guide the needle to the right spot. More than one injection may be required. Side effects of this treatment are fever or pain, but these effects can be managed through medication.
• Cryotherapy: Cryotherapy, also called cryosurgery, is used to kill cancer cells by freezing them. A cut is made in the abdomen, and a probe is inserted into the tumor. The probe freezes and kills the cancer cells. The treatment takes only about an hour, and patients have a quicker recovery. It is not commonly available in many hospitals. There is a risk of bleeding and damage to bile ducts with this treatment option.

Transarterial chemoembolization (TACE)
Chemotherapy is the use of medicine to destroy cancer cells. In the case of liver cancer, TACE is preferred to traditional chemotherapy. This method delivers high doses of chemotherapy directly to the tumor. It is considered to be more effective. A scan is done about six weeks after the procedure to check the effectiveness of the treatment. It is common for patients to develop a fever after the procedure. Some pain and flu-like symptoms may persist for up to a week after the procedure.

Radiation therapy
Radiation therapy is only used in specific cases to treat liver cancer. There are two types of radiation therapy. They are:

• Selective internal radiation therapy (SIRT): It is an internal radiation therapy that targets cancer in the liver. This method is used if the tumor cannot be removed via surgery.
• Stereotactic body radiation therapy (SBRT): SBRT is external radiation therapy. The patient will be asked to lie down on a table, after which a machine will target their liver to deliver high doses of radiation. It is done for people with small tumors which cannot be removed with surgery.

Treatment with medication
In addition to these therapies, doctors may recommend medication. Targeted medication therapy aims to kill specific particles in the cells which allow cancer to grow.