Liver, Gallbladder, and Bile Duct Cancer
A Unique Approach to Treating Liver Cancer
New therapeutic options are helping to improve the lives of patients with cancer in the liver and the biliary tree. A growing number of patients entrust their care to the experts at the Allegheny Health Network—one of a select group of health systems to have a program dedicated solely to treating patients with liver and biliary cancers.
We treat patients with primary liver tumors, as well as those with disease that has spread to the liver from other parts of the body. Our patients have access to cutting edge treatment options delivered by a dedicated, diverse team to treat the disease from different perspectives.
Physicians from medical oncology, surgery, diagnostic radiology, radiation oncology, hepatology, and interventional radiology meet each week to discuss the most appropriate treatment regimen for each patient. This process eliminates the need for multiple consultations and ensures that all available options are considered for each patient. We pride ourselves on this patient-centered approach to cancer care.
Liver Cancer Treatment Options
Surgical removal of the tumor may be the best option for some patients with cancer in the liver or the biliary tree. This is true for both primary liver cancer and some cancers that have spread to the liver from other sites. Depending on the size and location of the tumors, the extent of the surgery may involve a small segment of the liver, an entire lobe, or more. We use aggressive techniques to allow patients with extensive cancers to qualify for surgery. Even if surgery is not initially an option due to the extent of the disease, options such as radiation and chemotherapy can be used to downsize the tumors for surgery. We utilize a laparoscopic approach whenever possible. Learn more about liver and bile duct surgery techniques.
When necessary, we partner with our general or colorectal surgeons to combine our minimally-invasive liver surgery with any additional surgery that may be required at the same time. Both surgeons can use the same incision sites to minimize the number of procedures and the length of the patient’s recovery. This can be done to remove tumors from multiple sites in the body or for procedures such as ostomy reversal, when appropriate.
Stereotactic Body Radiation Therapy
For cases where surgery is not a good option, we can often offer stereotactic body radiation therapy (SBRT). Liver SBRT is a rapidly emerging, non-invasive technique that allows for precise delivery of high doses of radiation to isolated tumors. Compared to traditional radiation, it results in vastly improved outcomes with minimal complications and toxicity. Under the guidance of Dr. Alexander Kirichenko, Allegheny Health Network is one of the leading centers to perform this cutting edge treatment, which offers unprecedented tumor control to patients who are ineligible for surgery. In select patients, we can apply a combination of surgery for those tumors that can be removed and SBRT for those that cannot be removed to offer aggressive treatment where there was previously little hope. Liver SBRT treatments are usually delivered as an outpatient over just four to five days.
The images below demonstrate a liver cancer that is clearly decreasing in size just 3 months after completing SBRT in 5 treatment visits. In this particular patient, SBRT has allowed him to move forward with an evaluation for liver transplant.
In the next example, this patient had 8 different liver tumors that had spread from his prior rectal cancer. Seven of those tumors were removed with surgery, while the 8th was too deep to safely reach. That 8th lesion was treated with SBRT, allowing aggressive treatment of all sites despite his large number of tumors.
Here at Allegheny Health Network, we have countless examples of patients like these-- patients whose liver tumors responded dramatically to this SBRT treatment.
Embolization and Chemoembolization
In hepatic embolization, an interventional radiologist injects tiny particles into the blood vessels that feed the tumor, stopping blood flow to that part of the liver. These particles may also be soaked with chemotherapeutic agents to deliver those drugs directly into the tumor itself. The procedure can be repeated several times as needed. In select cases, chemoembolization may shrink the tumor or slow its growth.
Radioembolization involves the injection of tiny radioactive beads directly into the liver. An interventional radiologist enters a blood vessel in the groin and then guides a catheter up to the liver, right to the vessels that feed the tumors. The beads are injected through the catheter and implant themselves in the tumor bed. The cancer cells are then directly exposed to the radioactive element yttrium-90 within the beads. This technique may slow the progression of the tumor or cause it to decrease in size. This technique is frequently used in patients with tumors spread throughout the liver that cannot all be reached by another means.
Radiofrequency ablation (RFA) is another option available to treat liver tumors that cannot be removed with surgery. This procedure can be done by a surgeon in the operating room or by a radiologist in the hospital. A probe is inserted into the tumor and gives off electrical currents to potentially destroy the cancer cells. It is not ideal for larger tumors and is utilized on a case-by-case basis.
This aggressive modality may be an option for select patients with cancer that originated in the liver. The tumors must meet certain size criteria but may be downsized using some of the treatment methods listed above. Our multidisciplinary liver transplant team evaluates patients on a case-by-case basis to determine whether transplantation is appropriate.