Which liver tumours can be treated?
These treatments are used mainly for hepatocellular carcinoma (HCC), the most common primary liver cancer, usually seen in people with cirrhosis from hepatitis B, hepatitis C, alcohol or fatty liver. They are also used for selected liver metastases, for example from colorectal or neuroendocrine cancers.
The right option depends on the number and size of tumours, whether blood vessels are involved, liver function and your general health. Every plan is made together with your oncologist, hepatologist or liver surgeon, ideally at a multidisciplinary tumour board.
Radiofrequency and microwave ablation (RFA / MWA)
Ablation destroys the tumour with heat, using a needle electrode placed through the skin under ultrasound or CT guidance.
- Best suited for: small tumours, typically up to about 3 cm, and a limited number of lesions.
- How it works: radiofrequency current or microwave energy heats the tumour to over 60°C, killing the cancer cells along with a small margin of surrounding tissue.
- Results: for small HCCs, ablation is a curative-intent treatment and can achieve outcomes comparable to surgery in selected patients.
- Recovery: usually done under sedation or general anaesthesia, with an overnight stay and return to routine activity within a few days.
Microwave ablation heats faster and is less affected by nearby blood vessels, which makes it useful for slightly larger tumours or those close to vessels.
TACE: transarterial chemoembolisation
Liver tumours get most of their blood supply from the hepatic artery, while the normal liver relies mainly on the portal vein. TACE uses this difference.
- How it works: through a pinhole in the groin or wrist, a microcatheter is guided into the artery feeding the tumour. Chemotherapy, either mixed with lipiodol (conventional TACE) or loaded onto drug-eluting beads (DEB-TACE), is delivered directly into the tumour, followed by particles that block its blood supply.
- Best suited for: intermediate-stage HCC, with multiple or larger tumours that are not suitable for surgery or ablation, and preserved liver function.
- Goal: to control tumour growth and extend life. It is also used to keep a tumour in check while a patient waits for a liver transplant (bridging), or to shrink it so they become eligible (downstaging).
- Recovery: one to two days in hospital. Fever, abdominal pain and nausea for a few days (post-embolisation syndrome) are common and treated with medicines. TACE is often repeated based on follow-up scans.
TARE: transarterial radioembolisation (Y-90 / SIRT)
TARE, also called selective internal radiation therapy (SIRT), delivers radiation from inside the tumour.
- How it works: millions of microspheres containing the radioactive isotope yttrium-90 (Y-90) are injected through a catheter into the tumour's arteries. They lodge in the tumour's small vessels and give a high radiation dose over about two weeks, with little effect on the rest of the body.
- Planning: a mapping angiogram is done first, with a small test dose and a nuclear scan to check the blood flow and make sure the spheres will not reach the lungs or bowel. Treatment follows one to two weeks later.
- Best suited for: larger or multiple tumours, tumours involving the portal vein, and selected liver metastases. Radiation segmentectomy can treat a single tumour with curative intent.
- Recovery: usually a day-care or overnight stay, with tiredness for a week or two. Post-embolisation pain is typically milder than with TACE.
Comparing the options
| RFA / MWA | TACE | TARE (Y-90) | |
|---|---|---|---|
| Route | Needle through the skin | Catheter in the artery | Catheter in the artery |
| Typical use | Small tumours, about 3 cm or less | Intermediate stage, multiple tumours | Large tumours, portal vein involvement, metastases |
| Intent | Curative for small tumours | Control, bridge or downstage | Control, downstage, sometimes curative |
| Hospital stay | About 1 night | 1 to 2 nights | Day care or 1 night |
These treatments can also be combined, for example TACE followed by ablation, or used alongside systemic therapy.
Frequently asked questions
Is TACE or TARE a cure for liver cancer?
Ablation can be curative for small tumours. TACE and TARE mainly control tumours and extend life, and can make some patients eligible for surgery or a liver transplant. Which one suits you depends on your scans and liver function.
Which tests are needed before treatment?
A recent contrast CT or MRI of the liver, blood tests for liver and kidney function, and tumour markers such as AFP. For TARE, a planning angiogram and nuclear scan are also needed.
Can I get a second opinion on my liver scan?
Yes. Share your CT or MRI reports and images on WhatsApp so they can be reviewed before you visit.
This page is for general education and is not a substitute for medical advice. Treatment depends on your examination and test results.