Hepatobiliary Oncology (Liver Cancer)

Many curative treatments are available for patients with liver cancer.  A successful outcome depends in part upon the patient’s general health and the stage of the cancer. Montefiore Einstein Center for Cancer Care offers the entire spectrum of treatment options for patients with liver cancer, including:

• Angiographic (through the arteries) treatment
• Heated intraperitoneal chemotherapy
• Hepatic artery chemoembolization
• Liver transplantation
• Radiation therapy and ablation (destruction of tumors with heat or chemicals)
• Surgical resection
• Systemic therapy with medications

Due to the variety of treatment options and the usual presence of underlying liver disease, it is important that patients with liver cancer be evaluated at a specialized center with a comprehensive multidisciplinary care team dedicated to liver cancer. Not all treatments are appropriate for every patient, and in many cases, combinations of treatments are used rather than a single type of therapy. Therefore, each patient receives an individualized care plan.

About Liver Cancer
Primary liver cancer is caused by malignancy of the liver cells or bile ducts in the liver. Hepatocellular cancer (HCC) is caused by liver cells (hepatocytes), whereas cholangiocarcinoma is caused by bile ducts. In young children, liver cancer may be caused by a tumor called hepatoblastoma. Secondary liver cancer is caused by spread (metastases) to the liver from other cancers in the body. The most common type of liver cancer begins in the colon, but virtually any cancer can potentially spread to the liver.

Rates of primary liver cancer are increasing in the United States, unlike those of some other cancers, which have been decreasing in incidence. Many factors have contributed to this increase, such as a rise in the rates of hepatitis C infection, which over many years can cause both cirrhosis or liver scarring and liver cancer.

Although hepatitis C is an important factor in liver cancer, the hepatitis B virus is actually responsible for more cases of liver cancer worldwide. Patients from some parts of the world (especially sub-Saharan Africa, China and Southeast Asia) may be lifelong carriers of hepatitis B.

Diagnosis of Liver Cancer
Patients at higher risk for liver cancer are advised to undergo annual ultrasound examination of the liver and a blood test to determine the presence of alpha fetoprotein (AFP), a type of protein that is sometimes elevated in liver cancer. Most cancer in the liver, either primary or secondary, results in a tumor or mass formation in the liver.

Single or multiple tumors can be located in different parts of the liver. The cancer stage depends on the size of the tumor, the number of tumors, whether the tumor is confined to the liver and whether the tumor invades major blood vessels or arteries and veins in the liver.

Tumors larger than two centimeters can almost always be detected on imaging tests such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), whereas tumors less than one centimeter in diameter may be difficult to detect. If liver cancer is suspected, imaging exams will be required to confirm the diagnosis. Biopsy is also sometimes used to confirm diagnosis of suspected liver cancer.

Treatment Planning
At Montefiore Einstein Center for Cancer Care, all liver cancer patients are evaluated by a team that includes a hepatobiliary surgeon (liver surgeon), a hepatologist (liver medicine doctor), a liver medical oncologist, a radiologist and a radiation oncologist (specialist in radiotherapy). Each case is reviewed at a weekly liver cancer review conference where new treatment plans and progress are discussed. This assures patients and referring doctors that a thorough review of all available options has been performed. Patients may also take advantage of our psychosocial support services, nutrition support services and financial counseling to enrich their physical, spiritual and emotional well-being.