Digestive & Liver Diseases (Gastroenterology)
The Montefiore Comprehensive Liver Program offers the entire spectrum of treatment options for patients with liver cancer. Each case seen at the Center is evaluated on an individual basis, and every treatment plan is carefully constructed by our multidisciplinary team. Not all treatments are appropriate for every patient, and in many cases, combinations of treatments are used rather than a single type of therapy.
Liver resection is the removal of a part of the liver containing the tumor. Some patients with localized tumors in the liver and well-preserved liver function may be candidates for liver resection. As many patients are not candidates for liver resection, other treatment options are offered.
Liver resection, a major surgery, has a much lower rate of complications than in the past. The Montefiore Comprehensive Liver Program has a dedicated liver anesthesia team and an experienced, fully equipped support team in critical care to manage even the most complex hepatic operations. Minimally invasive (laparoscopic) liver resection is an option for selected patients, and offers significant benefits such as pain reduction and quicker recovery time.
Ablation destroys tumors in the liver with a needle (probe) that is inserted into the tumor, either by direct visualization during surgery or through the skin using imaging guidance by a radiologist. The tip of the probe is heated to cauterize the tumor tissue, or the needle is used to inject a chemical (usually absolute alcohol) to destroy the tissue but preserve the surrounding liver. For smaller tumors (less than five centimeters) and for patients who cannot undergo resection, ablation may be a suitable option. The Montefiore Comprehensive Liver Program uses ablation to treat both primary and secondary liver cancer. This treatment is sometimes used with other treatments to provide the best possible outcome to patients.
Transarterial Embolization (TAE or TACE)
Embolization is performed by an interventional radiologist who first conducts an angiogram (vascular imaging procedure) with a contrast agent injected into the liver. When the tumor is visualized with the contrast agent, the radiologist injects the artery leading to the tumor with fine particles to block its blood supply. In some cases, the particles are soaked in chemotherapy to aid tumor destruction. Particles are tagged with radiation therapy (Yttrium-90 radiolabeling), delivering targeted doses of radiation directly to the tumor.
TAE/TACE is commonly performed on patients who cannot undergo resection. This procedure is sometimes repeated to obtain full control of the tumor. Patients undergoing embolization are sometimes admitted overnight to the hospital, but unlike with surgery, there is no prolonged recovery period. Although TAE/TACE is generally used for primary liver cancer, the treatment is useful in treating some types of secondary liver cancer.
Medical (Systemic) Therapy
Conventional chemotherapy is infrequently used for primary liver cancer, but it may be used in addition to surgery for secondary cancer. Systemic treatment options for primary liver cancer (HCC) include a recently available FDA-approved drug, taken orally, called Sorafenib. Our medical oncology partners at the Montefiore Comprehensive Liver Program evaluate whether patients should receive just medical therapy or a combination of medical therapy and other treatments.
Although radiation therapy is an established means for treating solid tumors, only recently has radiation become part of the treatment for liver tumors. Several advances, such as novel technology for delivering focused radiation to specific targets with accuracy and safety (radiosurgery), now permit treatment of primary and secondary liver cancer. During multidisciplinary tumor case review meetings, the attending radiation oncologists evaluate patients for potential radiotherapy at the Montefiore Comprehensive Liver Program.
Liver transplant may be the best curative option for some patients with primary liver cancer. During liver transplantation, the entire liver is removed and replaced with a new liver, which is most commonly obtained from a brain-dead donor whose family has consented to organ donation. Not all patients benefit from liver transplantation, so a careful team assessment is necessary to determine if transplant is the right option. Liver transplantation is generally offered to patients with early-stage HCC (Stage I or II) who are not qualified candidates for resection due to the presence of advanced underlying liver disease. The waiting time for liver transplant can approach 18 months in some cases. During the waiting period, the patient is treated with other therapies to control the cancer and prevent growth and/or metastasis.