Hepatobiliary Tumors (Liver Cancer)
Primary liver cancer is a potentially fatal disease caused by malignancy of liver cells or bile ducts in the liver. Hepatocellular cancer (HCC) is the primary liver cancer caused by liver cells (hepatocytes), whereas cholangiocarcinoma is the primary liver cancer caused by bile ducts. In young children, tumor-induced liver cancer is called hepatoblastoma. Secondary liver cancer is caused by metastases, the spreading of cancer, to the liver. The most common liver cancer stems from the colon. Virtually any cancer can spread to the liver.
The rate of primary liver cancer is growing in the United States, while the rates of other cancers are decreasing. Although many factors have contributed to this trend, the increase is largely attributed to the hepatitis C virus, which causes both cirrhosis (liver scarring) and liver cancer.
Although hepatitis C is the leading cause of liver cancer, the hepatitis B virus is actually responsible for more cases of liver cancer worldwide. Patients (especially from sub-Saharan Africa, China, and Southeast Asia) may be lifelong carriers of hepatitis B.
Diagnosis of Liver Cancer
Current guidelines for liver cancer advise high-risk patients to take an annual ultrasound exam and an alpha fetoprotein (AFP) test, which is a blood test.
Most cancers of the liver cause the growth of one or several malignant tumors, or abnormal growth of cancerous body tissue, to appear in various parts of the liver. The cancer stage is determined by the size, number and location of the tumor or tumors. Another determining factor is whether the tumor is confined to the liver or has invaded major blood vessels (arteries and veins) in the organ.
Tumors over two centimeters can almost always be seen on imaging tests such as ultrasound, a computerized axial tomography (CAT) scan, or magnetic resonance imaging (MRI). Tumors smaller than one centimeter in size may be difficult to see if liver cancer is suspected, imaging exams and multiple tests will be required to help confirm the diagnosis. Biopsy is sometimes used to confirm diagnosis of suspected liver cancer.
Comprehensive Treatment of Liver Cancer
While liver cancer is a fatal disease when diagnosed in the late stages, many treatment options are available to patients with early-stage cancer. Surgical resection, liver transplantation, systemic therapy with medications, angiographic (through the arteries) treatment, radiation therapy and ablation (destruction of tumors with heat or chemicals) are treatment options available at the Montefiore Comprehensive Liver Program.
Our patients receive specialized care for both evaluations and treatments from a comprehensive multidisciplinary care team dedicated to liver cancer. Not all treatments are appropriate for every patient. In many cases, combinations of treatments are used rather than a single type of therapy, creating highly individualized care.
Advancements in the Treatment of Liver Cancer
Montefiore has made great advancements in the treatment of liver cancer. We use surgical techniques that minimize complications and maximize successful outcomes. Our results are truly outstanding, with a mortality rate significantly lower than the national standard. The overwhelming majority of our patients enjoy a return to normal liver function after surgery.
We have developed innovative therapies to tackle metastatic liver tumors (cancer spread from another site) when standard chemotherapy and surgery have ceased to work. In addition, we are pioneers in combining these techniques with vaccines to boost the body's immune system to further fight the cancer.
Treatment Planning at the Montefiore Comprehensive Liver Program
At the Montefiore Comprehensive Liver Program, all liver cancer patients are evaluated and discussed by a team made up of a hepatobiliary surgeon (liver surgeon), a hepatologist (liver medicine doctor), a liver medical oncologist, a radiologist and a radiation oncologist. Additionally, psychosocial support services, nutrition support services and financial counseling are available. Each case is assessed at a weekly liver cancer conference where the review team discusses new treatment plans and progress on current patients, thoroughly reviewing all available options.