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Primary Liver Cancer (Hepatocellular Carcinoma) Treatment

Primary Liver Cancer – Treatment at Sheba Medical Center

Primary liver cancer, called hepatocellular carcinoma, is a relatively common cancer worldwide, causing approximately 700,000 deaths per year. It begins in liver cells and develops within the liver itself. This cancer is not the same as metastatic (secondary) liver cancer, which originates in another organ and spreads into the liver. At The Center for Liver Diseases at Sheba, world-class doctors provide advanced and personalized treatments for patients with different types of liver cancer. We have a vast range of cutting-edge technologies, and we apply an integrative approach to treating each individual.

Primary Liver Cancer

What are the risk factors for primary liver cancer?

While the precise causes of all liver cancer are not fully known, several factors can increase your chances of developing hepatocellular carcinoma:

  • Chronic viral hepatitis: the most common risk factor is long-term infection with the hepatitis B or hepatitis C virus; 75-80% of cases can be attributed to viral hepatitis
  • Cirrhosis: most people who get liver cancer already have some signs of cirrhosis (liver scarring)
  • Excessive alcohol use: alcohol use is a leading cause of cirrhosis
  • Fatty liver
  • Tobacco use
  • Type 2 diabetes
  • Obesity
  • Gender: primary liver cancer is much more common in men than in women

What are the types of primary liver cancer?

Primary liver cancer starts in the liver, and metastatic liver cancer begins elsewhere in the body and spreads to the liver. Because the liver is relatively large and has a high blood flow, it is a common target for tumor cells that are flowing through the bloodstream. The most typical sources of metastatic liver cancer are lung, colorectal, and breast cancer. There are a few main types of primary liver cancer:

Hepatocellular carcinoma (HCC)

These cancers start in hepatocyte cells and make up the majority of cases of primary liver cancer. They can begin as a single tumor or as multiple spots in the liver.

Fibrolamellar HCC

This is a rare subtype that is associated with more successful treatment outcomes than other liver cancers.

Bile duct cancers (cholangiocarcinomas)

Approximately 10-20% of all liver cancers begin in the bile ducts; they are treated the same way as HCC.

Angiosarcomas and hemangiosarcomas

These fast-growing cancers begin in blood vessels in the liver.

The stages of primary liver cancer

In addition to identifying the type of primary liver cancer, staging the liver tumor is essential for planning the most effective treatment.

| Stage 1

A single, small tumor in the liver, which has not spread

| Stage 2

Tumor is larger and/or has started to damage blood vessels in the liver

| Stage 3

Tumor is starting to spread and has penetrated blood vessels or nearby organs and lymph nodes

| Stage 4

Metastasis; the tumor has spread to distant organs via the lymphatic system or bloodstream

What are the symptoms?

In the early stages of primary liver cancer, most people do not experience any symptoms. Signs may develop later and most commonly include:

  • Weight loss
  • Jaundice
  • Upper abdominal pain, often in the right side of the body
  • Nausea and vomiting
  • Lack of appetite
  • Fever
  • Abdominal swelling from an accumulation of fluid in the abdominal cavity

What Specific Treatments Does Sheba Offer?

Sheba Medical Center offers the most effective, modern therapies to treat liver cancer, and multidisciplinary specialists collaborate to optimize and customize each patient’s treatment. Primary Liver Cancer Treatment in Israel options include:


The main treatment for primary liver cancer is surgery, involving a partial and highly selective resection. Skilled surgeons must operate in a way that removes enough of the tumor to treat the cancer, but leaves enough of the liver to preserve its ability to function. Sometimes, surgery cannot be performed, because of the tumor’s location within the liver, advanced cirrhosis and liver failure, or the spread of the tumor outside the liver.


This innovative treatment involves inserting a needle into the center of the tumor, which guides strong radio waves to heat the cancer cells up to 100°C, thereby destroying them. Ultrasound or CT is used to guide the needle precisely. Ablation works directly and locally, without causing damage to nearby healthy tissue. Done under local anesthesia, this therapy can be used to eradicate smaller tumors that do not have a diameter greater than 5cm or when the patient is not a good candidate for surgery.

Transarterial Chemoembolization (TACE)

During this therapy, a catheter is inserted into the artery of the liver and chemotherapy is administered directly into the artery that is feeding the tumor. Afterwards, the artery is blocked, which results in necrosis of the cancer. The combination of administering chemo and blocking the artery increases the total effectiveness of the therapy. Local anesthesia and x-ray are used, and chemoembolization can be repeated a few times, if necessary.

Another method of this therapy injects beads that are filled with chemotherapy drugs into the liver artery, thereby reaching the tumor directly.

While chemoembolization is regarded as life-prolonging, it does not cure the cancer. This treatment may be used for cases of primary liver cancer that are not appropriate for surgery or ablation.

Radioembolization – Selective Internal Radiation Therapy (SIRT)

SIRT involves injecting small glass pellets coated with yttrium-90 (a radioactive substance; a source of beta-radiation) into the hepatic artery. These little balls get stuck in the small blood vessels of the tumor, resulting in localized irradiation and necrosis of the tumor. Using this method, a large dose of radiation is concentrated in the tumor without damaging healthy liver tissue.

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Biologic treatments

Growth inhibitors can be given to a patient with advanced primary liver cancer in which the cancer has become metastatic; these drugs affect the tumor’s ability to develop and grow. The oral drugs come in pill form and are administered as a single treatment. This therapy helps to prolong life and is generally used when other treatment options (as listed above) are unsuitable.

Meet Our Doctors

Einat Shacham-Shmueli
Einat Shacham-Shmueli, MD
Senior Oncologist, Gastrointestinal Clinic at the Cancer Center
Dr. Shacham-Shmueli is involved in specialized research in the fields of gastrointestinal malignancies, cancer and genetics, and she has published 25 original scientific articles. She is a member of the Israel Society of Oncology and Radiotherapy, and she is an investigator for the NCI (National Cancer Institute), RTOG (Radiation Therapy Oncology Group), and CTEP (Cancer Therapy Evaluation Program).
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Eylon Lahat, MD
Senior Physician, Department of Liver and Pancreas Surgery
Dr. Lahat is a world-renowned specialist in liver, pancreatic, and gallbladder surgery. In addition to his position at Sheba, he is a member of the clinical staff at the Liver Transplant and Liver and Pancreas Surgery Department at Henri Mondor Hospital in France. Dr. Lahat is also a lecturer, consultant, and education coordinator for English students at Sheba. He has published more than 30 articles in medical journals.
Daniel Azoulay
Daniel Azoulay, MD
Senior Surgeon, Center for Liver Diseases
Prof. Azoulay is one of the world’s leading surgeons in the field of complex liver surgeries and liver transplants, having performed more than 1,500 liver transplants to date. He is highly experienced in surgical shunts, liver ablation, in situ hypothermic perfusion of the liver, and split liver transplantation. He studied medicine at the University of Paris, and worked for 22 years as a senior surgeon at the Hepatobiliary Center at Paul Brousse Hospital. For seven years, he has been Chief of the Department of Digestive, Hepato-Pancreato-Biliary and Liver Transplantation Surgery at Hôpital Henri Mondor (University Hospital) – Assistance Publique-Hôpitaux de Paris. Dr. Azoulay has published more than 400 articles in international medical literature.
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Gil Golan, MD
Senior Physician, Division of Diagnostic and Interventional Imaging
Specializing in a range of medical conditions, Dr. Golan’s main interests and areas of research include invasive gynecologic and obstetric treatments (such as endovascular therapy of the placenta and the treatment of fibroids), endovascular treatment of varicose veins, and endovascular treatments in oncology patients.
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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone.

We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

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