Liver Cancer

Primary Liver Cancer and Metastatic Liver Cancer

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Duke medical and surgical oncologists specialize in the treatment of primary liver cancer, which starts in the liver, as well as secondary liver cancer -- also known as metastatic liver cancer -- which spreads to the liver from cancer that started elsewhere in the body. We use the latest medical and surgical approaches, interventional radiology procedures, and radiation therapies to aggressively treat these cancers. We also offer advanced techniques that are only available in a handful of cancer hospitals across the country.

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What is Liver Cancer?

Primary Liver Cancer
Cancer that starts in the liver is known as primary liver cancer; the most common type is hepatocellular carcinoma (HCC); the less common type is cholangiocarcinoma (also known as bile duct cancer). Primary liver cancer often occurs in people who have chronic liver diseases, such as cirrhosis. It can be treated effectively if caught early.

Metastatic Liver Cancer
Metastatic liver cancer starts as primary cancer elsewhere in the body -- most frequently as colorectal cancer -- and spreads to the liver. While metastatic liver cancer is infrequently cured, treatment can control your symptoms and prolong survival.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosing Liver Cancer

Your doctor may recommend these tests be performed to confirm your diagnosis and determine the size, location, type, and stage of your liver cancer.

Blood Work

Blood tests look for the presence of liver enzymes and proteins, which indicate the presence of liver cancer. Blood tests also measure how well your liver is functioning.

Imaging Tests

A combination of CT scans, MRI, PET scans, and ultrasound may be performed to look at the size and location of the tumor. While you may have undergone these tests before coming to Duke, your Duke doctor may repeat them to personalize your treatment recommendation.


While some liver tumors can be diagnosed based on scans, in other cases a biopsy may be necessary to confirm your diagnosis. During this procedure, a tissue sample is removed from your liver, most commonly using a needle guided by live CT or ultrasound. The tissue sample is examined under a microscope to detect cancerous cells and confirm a diagnosis that is in question.

Liver Cancer Treatment Options

Treatment of primary and metastatic liver cancer can be similar; however, your treatment plan will be personalized to your needs. One or more of these approaches may be part of your plan.

Liver Resection

Surgical removal of your tumor(s) is often the first line of treatment. Doctors refer to this as liver resection or partial hepatectomy. During this operation, the surgeon removes the diseased portion of the liver and leaves enough liver behind for it to continue to function. When possible, the liver is accessed through small incisions in the abdomen. This minimally invasive approach is called laparoscopic surgery or robotic surgery. These approaches may reduce your pain and scarring and shorten the time you stay in the hospital. These operations can be performed for primary and metastatic liver cancer.

Liver Transplant

A liver transplant may be an option if you are diagnosed with primary liver cancer, specifically hepatocellular carcinoma. On rare occasions, it may be performed for hilar cholangiocarcinoma if you meet specific requirements. During this procedure, your surgeon removes the diseased liver and replaces it with a healthy liver from a donor.

Systemic Chemotherapy

Systemic chemotherapy floods the whole body with chemotherapy. The drugs are administered through an IV or through a port that is inserted in your chest. Systemic chemotherapy can be prescribed for primary or metastatic liver cancer.


Embolization is the delivery of small beads or material into the arteries that directly feed the tumor. Ultimately, they choke off the blood supply, which results in cancer cell death.


Chemoembolization uses pellets or beads to block or reduce blood flow to the tumor and also slowly releases chemotherapy directly to the tumor site. The tiny materials are injected through a catheter into a blood vessel that supplies the tumor. 


Radioembolization is similar to chemoembolization; however, in this case, the tiny pellets or beads are bound to radioactive material that is injected through a catheter into a blood vessel that supplies the tumor. The beads block or reduce blood flow to the cancerous tumor and also deliver radiation directly to the tumor.

Hepatic Artery Infusion Pump

A pump is surgically implanted in the abdominal wall, and a catheter is used to deliver doses of chemotherapy hundreds of times higher than systemic chemotherapy. Drugs are delivered through the hepatic artery, which directly feeds tumors in the liver. It is given in combination with systemic chemotherapy but it does not increase the side effects. Hepatic artery infusion is used to treat metastatic colorectal cancer to the liver as well as primary liver cancer (intrahepatic cholangiocarcinoma) that cannot be surgically removed.

Targeted Therapy

Targeted therapy may be given based on specific genetic and molecular changes in the tumor. It blocks proteins in cells that cause cancer or promote tumor growth.

Radiation Therapy

Stereotactic body radiation therapy (SBRT) targets high-energy radiation directly at the tumor to shrink it and kill the remaining cancer cells. SBRT minimizes radiation exposure and damage to the surrounding healthy tissue.

Microwave Ablation

This procedure involves the insertion of a needle to deliver high-energy microwaves directly to the tumor to destroy cancer cells. It may be performed by an interventional radiologist or in the operating room. It is used to treat primary and metastatic liver cancer.

Radiofrequency Ablation

Radio waves heat and destroy cancer cells. This may be prescribed to treat small primary liver tumors that are inoperable because of underlying liver disease. This treatment is used less frequently but may be recommended to help manage pain and discomfort from liver cancer.

Why Choose Duke

Nationally Ranked Cancer Program
As a National Cancer Institute-designated Comprehensive Cancer Center, we are recognized for exploring new treatment opportunities through ongoing clinical trials. We offer you the latest research discoveries before they are available elsewhere. We are also part of the National Comprehensive Cancer Network (NCCN), an alliance of the nation’s leading cancer centers dedicated to improving care for our patients.

Highly Skilled Medical and Surgical Oncologists
Our skilled, experienced medical and surgical oncologists use a personalized approach to treat your cancer. This may include small incisions and robotic technology to remove diseased portions of the liver during complex operations. Our experience is evidenced by the number of surgical procedures we perform each year and by the successful outcomes we achieve.

Experienced with Hepatic Arterial Infusion
Our medical and surgical oncologists are among the few U.S. doctors with the training and expertise needed to offer hepatic arterial infusion, or HAI. The chemotherapy infusion pump can prolong survival in people with liver metastases and primary liver cancer.

Large Liver Transplant Program
If your type of primary liver cancer progresses to the point where a liver transplant may be an option, we have one of the best and highest volume liver transplant programs in the country. We maintain outstanding survival rates for people who need a liver transplant.

Safer Imaging Options
We offer wider and shorter MRI machines so you will be more comfortable during imaging. Our CT scans are equipped with the highest quality imaging and require a lower radiation dose, which minimizes your exposure to radiation. Our abdominal imaging radiologists have special expertise in liver imaging.

Access to Clinical Trials
You may be eligible to participate in our ongoing clinical trials, which test new therapies before they become available elsewhere.

Your Care in One Setting
We value your time and are committed to providing efficient services. For your convenience, you will see many specialists for evaluation during your appointment so you have the personalized recommendations and information you need to make informed decisions about your care.

Support for You and Your Loved Ones
Our comprehensive cancer support services range from helping you minimize the side effects of treatment to coping with the emotional and psychological effects of diagnosis and treatment. View all of our cancer support groups in our event calendar.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

Patient Resources

This page was medically reviewed on 01/16/2023 by