Liver, Bile Duct, and Gallbladder Cancer Center of Excellence

What we treat

Whether treating cancer, hepatocellular carcinoma (HCC), or biliary tumors, our clinic provides advanced, personalized care that combines the latest in medical technology with a compassionate approach, aiming to improve both survival and quality of life for our patients.

Curative treatments for early-stage cancers

For patients with early-stage cancers of the gallbladder, bile duct, or liver, such as HCC, we offer curative treatments including:

• Surgery:
  • Surgical resection and liver transplantation: Remove the tumor while preserving healthy tissue.
  • Minimally invasive and robotic surgery: Facilitates speedy recovery and is less likely to damage other areas of the body.
  • Biliary bypass: If the tumor is blocking the bile duct and cannot be removed, a bypass procedure may be performed to create a new pathway for bile flow.
  • Whipple procedure (Pancreaticoduodenectomy): This complex surgery is often used for pancreatic cancer in the head of the pancreas and involves removing the head of the pancreas, part of the small intestine, the gallbladder, and part of the bile duct.
• Ablative therapies: These may be used for smaller liver tumors or in combination with other treatments.
  • Percutaneous ablation: Microwave (heating) and cryo (cooling) ablation using a small needle placed within the tumor using ultrasound or CT-scan guidance.
  • Percutaneous pulsed electric field ablation: Uses electrical energy to destroy tumor cells near critical structures like blood vessels and other organs. This treatment also unlocks tumor recognition, which trains the immune system to better fight cancer elsewhere in the body.

Neoadjuvant treatments for advanced cancers

This treatment is administered before surgery to shrink tumors and increase the likelihood of successful surgery, potentially changing an inoperable tumor into one that can be surgically removed. Options may include:

• Systemic therapies: Cutting-edge chemotherapy and targeted agents, selected based on the tumor’s molecular profile and the patient’s overall health.
• Targeted agents for biliary tumors: FGFR inhibitors, IDH1 inhibitors, and others, depending on the tumor's genetic mutations.
• Immune checkpoint inhibitors: Durvalumab, trametinib, atezolizumab, nivolumab, and pembrolizumab. Used in both HCC and biliary tumors to boost the body’s immune response against the cancer.
• Systemic therapies for advanced HCC:
  • Small molecule inhibitors such as lenvatinib and cabozantinib.
  • Combination therapies that pair chemotherapy with targeted treatments.

Treatments for metastatic tumors

Our clinic also treats metastatic tumors (tumors that have spread from other sites) including colorectal cancer and neuroendocrine tumors, among others. This is treated through:

• Surgery: When possible, surgery is used to remove metastatic tumors. The goal is to remove as much of the cancer as possible, which can help improve the effectiveness of other treatments and improve your overall outcome.
• Systemic therapy: This refers to treatments that travel throughout the entire body to target cancer cells wherever they may be.
• Locoregional approaches: These are treatments that are delivered directly to the tumor site or the surrounding area. For example, we offer Peptide Receptor Radionuclide Therapy (PRRT), also known as Lutathera, for metastatic neuroendocrine tumors. This therapy uses a radioactive drug that specifically targets neuroendocrine tumor cells, delivering radiation directly to the tumor while minimizing damage to healthy tissue.

Advanced Locoregional Treatments for HCC and Biliary Tumors

Treatments offered here include transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) for both HCC and biliary tumors.

• Transarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumor and blocks its blood supply.
• Transarterial Radioembolization (TARE): Delivers radioactive beads for targeted radiation therapy.
• Minimally invasive catheter-based therapies: Yttrium-90 (Y-90) radioembolization including ablative (curative) dose radiation segmentectomy and transarterial chemoembolization (TACE).
• Hepatic Artery Infusion (HAI) Pump Therapy: This therapy is a specialized treatment where a small, surgically implanted pump continuously delivers chemotherapy drugs directly to the liver through the hepatic artery. This method allows for a concentrated dose of medication to target liver tumors while minimizing systemic side effects.

Stereotactic body radiotherapy (SBRT)

This state-of-the-art treatment approach is used for primary and metastatic liver tumors. It is also an outpatient treatment, meaning no hospital or recovery time, with often minimal to no side effects. Instead of conventional radiotherapy, SBRT is a low-dose radiation delivered daily for up to two months. SBRT technology delivers powerful radiation to the cancer in just one to five days over 15- to 20-minute sessions.

This treatment, used alongside minimally invasive surgery, can help preserve livers in patients with cancer that has spread to the liver in a way that makes it impossible to surgically remove.

For those with HCC and associated liver cirrhosis, we have a special liver planning technique where the liver is mapped with notes on healthy liver volumes during 3D Conformal SBRT delivery. SBRT treatment helps patients with liver cancer (specifically, hepatocellular carcinoma) and serious liver scarring (called cirrhosis) before they get a liver transplant. It keeps their liver working well after the radiation, so they can stay safely on the waiting list for a new liver until a good match is found for their transplant.

Additional support

Beyond medical treatment, our clinic emphasizes holistic care, ensuring that each patient receives comprehensive support throughout their treatment journey. We provide nutritional support, pain management, and psychological counseling to enhance quality of life and address the physical and emotional challenges of living with cancer. We also offer rehabilitation and pre-habilitation for those undergoing treatment. Our commitment to compassionate, individualized care extends to every aspect of treatment, ensuring that our patients receive the best possible care tailored to their specific needs.

Clinical trials

Our clinic is also at the forefront of research, offering patients access to clinical trials that explore new chemotherapy combinations, targeted therapies, and immunotherapy options for both HCC and biliary tumors. These trials provide opportunities to benefit from the latest advancements in cancer treatment, often before they are widely available.

Liver, bile duct, and gallbladder cancer specialists

The AHN liver, bile duct, and gallbladder cancer specialists available to treat your specific case are some of the most highly skilled and compassionate providers to treat these challenging diseases. Working with an AHN provider means you have access to comprehensive and tailored care that will allow you to focus on healing.

Transplant/Hepatobiliary Surgery

Surgical Oncology

Use Find Care for a list of surgical oncologists.

Medical Oncology

Use Find Care for a list of medical oncologists.

Radiation Oncology

Use Find Care for a list of radiation oncologists.

Interventional Radiology

Use Find Care for a list of interventional radiologists.

Use Find Care to find AHN providers who treat liver, bile duct, and gallbladder cancer.

How to get care

At your appointment, you should expect to meet with a liver tumor specialist who will discuss treatment options, outcomes and expectations. This may include review of your prior imaging, lab results and pathology results. Patients are then discussed at our multidisciplinary tumor board to confirm the treatment plan and provide the opportunity for the best possible approach. We will also address any questions you or your supporters (family, friends, etc.) may have regarding your liver tumor and upcoming treatment.

For care, please call:

• Medical Oncology and Radiation Oncology: 412-578-HOPE 412-578-4673
• Surgical Oncology: 833-246-7662
• Hepatopancreaticobiliary and Transplant Surgery: 412-359-6738
• Interventional Radiology: 1-833-VIR-RAD1

Second opinions

If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A Nurse Navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.

Clinical trials and research

Clinical trials offer eligible patients who volunteer to participate new options for cancer treatment with novel uses of medications, radiation or surgical techniques with the goal to improve cancer treatment as a whole.  

You can discuss available active clinical trials with any of your liver tumor specialist providers and determine your eligibility to participate.

Currently active liver tumor clinical trials at AHN include:

• DOORwaY-90 Study: The first prospective, multicenter study evaluating the efficacy and safety of SIR-Spheres in HCC using personalized dosimetry. 
• HAI Registry: All patients who undergo HAI pump placement are included in a registry to track outcomes following pump placement.
• EA2222/PUMP: Phase III clinical trial that compares the addition of HAI pump therapy to standard of care chemotherapy in patients with unresectable colorectal liver metastases.
• ERASur: Phase III clinical trial comparing total ablative therapy and usual systemic therapy to systemic therapy alone in limited metastatic colorectal cancer.
• ARTxOnc: Liver transplant for unresectable colorectal liver metastasis.

Cancer clinical trials and research

The AHN Cancer Institute is a pioneer in cancer research and participates in clinical trials of new medical oncology therapies that are open for patients who qualify and wish to participate. Patients are screened for consideration with ongoing clinical trials at every stage of their treatment.

What is a clinical trial?

Clinical trials are studies that try to answer questions about new ways to treat cancer with medications, radiation, or surgical techniques. Previous trials have shown how new methods of treatment improve survival and quality of life and reduce the risk of cancer returning.You participate in a clinical trial only if you volunteer to do so and meet criteria for inclusion in the study, and you can stop participating in a trial at any time.

Who can join a clinical trial?

The plan for the trial, called a protocol, explains what the trial will do and how the study will be done. Based on the questions the research is trying to answer, each clinical trial protocol outlines specific criteria necessary to be eligible to join the trial.

Common criteria for entering a trial are:

• Having a certain type or stage of cancer.
• Having received a certain kind of therapy in the past.
• Being in a certain age group.

Federal rules help ensure that clinical trials are run in an ethical manner, with your rights and safety protected. It’s to ensure that you’re not put at increased risk by participating in the trial, and that the results of the study are accurate and meaningful.

Currently active clinical trials

If you would like to participate in a clinical trial and help our innovative team discover groundbreaking cancer solutions, ask your doctor if you’re eligible to participate in one. Find currently active clinical trials that are open for participation.

Refer your patient to an AHN specialist

There are two ways for medical professionals, who are not a part of Allegheny Health Network, to refer their patients to an AHN specialist and request their first appointment. You can:

1. Call 412-359-6738 to schedule with the Hepatobiliary Surgery and Liver Transplant teams.
2. Go to Find Care to find the right AHN specialist and the most convenient location. Then refer your patient, provide relevant patient details, and request an appointment directly from the doctor's profile.

For more information about referring your patient to an AHN specialist, read the Independent Physician Referral FAQs.