The liver, one of the largest organs of the body, occupies the upper right region of the abdomen and is essential for metabolism, digestion, detoxification of body impurities, and the storage of various nutrients and enables the coagulation of blood.
Malignancy of the liver is the uncontrolled proliferation of abnormal cells. In this blog, we will discuss the final stage of liver cancer, including expectations for care, along with the signs and symptoms commonly associated with this stage.
What is the last stage of liver cancer?
The standard staging system for liver cancer utilizes the malignancy's specific tumor size, its anatomical position in the liver, and its remote metastasis, if any, to other structures in the body, as staging criteria. Stage IV or Stage 4 liver cancer is most advanced in the disease progression and is associated with the cancer metastasizing beyond the liver to the contiguous or distant organs as well as lymph nodes.
At this stage, the cancer most often metastasizes to the lungs and bone.
Because of liver damage caused by underlying liver conditions, this stage is particularly difficult to manage. Cirrhosis and hepatitis are two cirrhotic underlying liver conditions. Damaged liver function and liver cancer, particularly in this stage, pose serious, and often life-threatening hazards, and severely limit the treatment options available.
Further, most experts divide this Stage 4 classification into two further subdivisions:
Stage 4A: The cancer is associated with metastasis into adjacent lymph nodes, but absent a distant organ metastasis.
Stage 4B: The cancer is associated with distant organ metastasis, most frequently to the lungs or bones.
Determining the precise stage aids in effective tailoring of treatment options and predicting the disease progression.
What Are the Symptoms in Stage 4?
In this stage, the body starts to show signs more clearly. These are some things I usually see in my patients:
● Ongoing fatigue: Even after resting.
● Loss of appetite: They just don’t feel like eating.
● Jaundice: That yellow tint in skin or eyes.
● Swelling in the belly: We call it ascites.
● Weight loss: Suddenly, without trying.
● Pain: Usually in the upper right side of the abdomen.
● Confusion or forgetfulness: This happens if the liver can’t filter toxins properly.
Now, not everyone has all these. Some have just two or three. Some have different ones. But when I see this picture coming together, I know we’re in the advanced stage.
What Is Targeted Therapy? And How Does It Work?
Let me explain this without getting too technical.
Targeted therapy works by attacking specific parts of the cancer cell—parts that healthy cells don’t have. So the damage is more focused. Less harm to your body. More control over the disease.
For some liver cancer patients, we now use a combination of two drugs:
Bevacizumab and Atezolizumab.
Bevacizumab stops the cancer from forming new blood vessels. That means it can’t feed itself, can’t grow.
Atezolizumab is an immunotherapy. It helps your immune system recognize and fight the cancer. It removes the “invisibility cloak” that cancer often uses to hide.
This combination has shown real results. In fact, it became a standard option for advanced liver cancer because of a major study.
What Did the Study Show?
In one large trial, patients who got Bevacizumab + Atezolizumab lived longer than those who got older treatments like sorafenib.
Median overall survival went beyond 19 months, which is significant in Stage 4 liver cancer. And some patients did much better than expected.
Even better? Many had stable disease for a long time. Their cancer didn’t grow. Their symptoms stayed under control.
It’s not a miracle. But it’s progress. And for the people who respond, it means birthdays, anniversaries, laughter, and more time with their families.
What About the HIMALAYA Trial?
Let me tell you about something we now use more often—the HIMALAYA trial. I’ve had this conversation with quite a few of my patients.
In this study, doctors tried a new combination—Durvalumab and Tremelimumab. Both are immunotherapy drugs, but they work in different ways.
Durvalumab helps the immune system spot the cancer. Tremelimumab makes that response stronger by taking away some of the natural blocks your immune system puts up.
When used together, they gave better results. Especially in people who had decent liver function and weren’t too weak to begin with.
Some patients lived longer than three years. That might not sound like much, but for someone with Stage 4 liver cancer, that’s a big deal. A decade ago, we didn’t even think that was possible.
So yes—there is hope. And it’s backed by evidence, not just emotion.
What Can a Medical Oncologist Do?
A lot. We don’t just write chemotherapy prescriptions.
We look at scans. We read reports. But more than that, we read you.
Your energy. Your symptoms. Your hope. Your fears.
Then we build a plan. One that works for you, not just against the cancer.
I always balance two things: how long you live and how well you live.
And when it works, it’s beautiful. I’ve had patients travel again. See weddings. Hold their grandkids. Smile without pain. That’s what we aim for.
Final Thoughts
Stage 4 liver cancer is hard. I won’t say otherwise. But it’s not the end. Not if we act early. Not if we act smart.
With Bevacizumab + Atezolizumab, or Durvalumab + Tremelimumab, we can now give patients more time than we ever could before.
Time to live. Time to prepare. Time to love.
If you or your loved one is facing this, don’t sit in silence. Seek medical advice Or reach out to the best medical oncologist in gurgaon. There’s always something we can do. We may not change the diagnosis. But we can absolutely change the story.
