Let's move on to the treatment of liver cancer. Basically, the treatment of liver cancer comes down to whether the patient is a surgical candidate or not. So a patient who is potentially resectable, has stage one and or two cancer, and is Childs-Pugh class A or B. If the patient fits these criteria, they are potential candidates for liver transplant for cure. Of course they must meet other transplant criteria, but liver transplant is actually considered the best therapy for stage I and II liver cancer. If patients are not eligible for liver transplant, they may be potential candidates for surgical resection. The surgeon needs to be able to leave enough normal liver there, which is considered adequate liver reserve, and it certainly the patient can't have any portal hypertension. Stage one and two patients are also potential candidates for what are called locoregional therapies. Locoregional therapies will be covered as we talk about unresectable liver cancer. So what about unresectable liver cancer when a tumor can't be operated on or is too big to leave adequate liver reserve? Well, these patients still may be eligible for liver transplant, although that's pretty rare. In non transplant candidates locoregional therapy is preferred and if that's not possible, systemic therapy. What are locoregional therapies? Essentially, they're ways to try and ablate the liver cancer. Ablation may be curative if the tumor is less than three centimeters in size, but it can also prolong survival. When the tumor is bigger than than three centimeters in size, but generally less than five centimeters in size. Ablation can be done in several ways through radiofrequency, through freezing or cryoablation, through percutaneous alcohol ablation, or even microwave therapy. Another locoregional therapy is arterial-directed therapies. Arterial-directed therapies are based on the ability to isolate an arterial blood supply to the tumor. The doctors then feed a catheter into the liver through the artery to embolize the liver cancer. With chemotherapy, drug-eluting beads, or radiotherapeutic microspheres. By killing the blood supply of the tumor, the tumor then dies. Another form of locoregional therapy is external beam radiation therapy. This is often used for patients with multiple lesions, who are not eligible for other locoregional ablative therapies. Radiation therapy can be given in the form of stereotactic body radiation therapy or SBRT, intensity-modulated radiation therapy, IMRT or 3D conformational radiation therapy. Any of these radiation therapies is considered palliative and not curative. Systemic therapies for liver cancer are very limited, the best agent is a drug called Sorafenib or Nexavar. It is a targeted therapy. This is a tyrosine kinase inhibitor against vascular endothelial growth factor receptor, platelet derived growth factor receptor, and the RAF kinases. It only should be used in Child-Pugh class A patients. It only increases median survival by approximately three months. It is now being tested in conjunction with locoregional therapy to try and increase survival. Besides Sorafenib, clinical trials are constantly being tested for patients with liver cancer. This ends our section on treatment for liver cancer. Thank you for taking introduction to liver cancer. We hope that you can now define risk factors for liver cancer, that you understand the current liver cancer screening guidelines. You understand liver cancer staging. Understand treatments for localized liver cancer. And understand treatments for advanced liver cancer. Liver cancer continues to be a devastating disease around the world. Because it is often caught so late when patients are already symptomatic. It is often untreatable, which reflects that we have 700,000 new cases diagnosed every year but also 600,000 deaths every year. This course helps develop a basic understanding of liver cancer but does not replace going to see a healthcare provider if a person has a diagnosis of liver cancer.