Liver cancer involves tumors, or abnormal growths, occurring on or in the liver, bile ducts and the tubes that carry bile from the liver or gallbladder to the small intestine, called the biliary tract. Tumors of the liver are categorized as primary or metastatic. Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. HCC shows an association with hepatitis B and hepatitis C infection. Surgical and interventional methods are available to help treat patients with this cancer.

Metastatic tumors of the liver are frequently seen from primary cancers such as colon, gallbladder, pancreas, breast, gastric or neuroendocrine tumors. These tumors metastasize and enter the liver by bloodstream. Colon cancer is the most common cancer metastatic to the liver that responds well to aggressive treatment. Aggressive treatment has resulted in a significant improvement in survival and potential cure rates in many cases. Surgical and interventional methods to treat these tumors are available.

Pancreatic cancer involves tumors, or abnormal growths, that form from the pancreatic ductal cells. It has been found that approximately 70 percent of malignant pancreatic tumors are found in the head of the pancreas. Without treatment, these tumors are uniformly fatal with survival rare one year after diagnosis. Patients with pancreatic cancer may be candidates for surgical resection, radiation, chemotherapy, or combinations of all three therapies. To learn more about pancreatic cancer, visit the Pancreatic Cancer Action Network.

What are the symptoms?

While many patients with liver and pancreas cancer have no symptoms, some might experience:

• Jaundice
• Decreased appetite
• Weight loss
• Fever
• Fatigue and weakness
• Bloating and abdominal discomfort

Why is a specialized team needed?

The diagnosis and management of hepatobiliary malignancies involve state-of-the-art technology, as well as advanced surgical skills. The team at St. Joseph is a highly trained group of physicians who can treat all aspects of this complex group of illnesses.

Experienced with the most advanced technology and surgical methods, The Hodes Liver and Pancreas Center at St. Joseph offers patients more options and advantages than were ever available for the treatment of hepatobiliary disease.

There are three methods used to treat and manage liver and pancreatic cancer: chemotherapy, interventional radiology and surgery. These treatments are conducted by skilled oncologists, interventional radiologists and hepatobiliary surgeons.

Chemotherapy

Medical oncologists employ the most recent advances in chemotherapy, drugs administered to fight cancers in the pancreas, liver and bile ducts. Which are the most appropriate agents to use will depend largely on the suspected site of origin of a cancer. Recent advances have brought oral treatments and targeted, substantially less toxic, agents into use in treating various cancers which commonly spread to the liver, particularly those from the colon, lung, and breast. These agents generally act systemically on the entire body to wipe up stray cancer cells. They thus often complement those used in hepatic artery infusions pumps or chemoembolization procedures. They can also be given along with or sometimes instead of conventional chemotherapy agents and may be useful in consolidating and prolonging the results obtained by surgical or radiological interventions.

Interventional Radiology Treatments

When surgery to remove a tumor is not an option, other treatments may be employed. Patients of The Hodes Liver and Pancreas Center have full access to St. Joseph's Interventional Radiology Department which employs the latest technology, including a state-of-the-art 64-slice CT scanner -- and the Innova® 4100, an all-digital imaging system. This technology allows for precise and minimally invasive treatment procedures for patients with liver metastasis or primary liver cancer, who are not candidates for surgery.

• Radiofrequency Tumor Ablation (RFA) (CT-Guided)
  RFA, usually performed on an outpatient basis, involves inserting a special needle into the liver tumor using a CT scanner for guidance. Once the needle is inserted, a group of thin wires opens within the tumor from the tip of the needle. From these wires, radiofrequency energy is transmitted, producing heat from the tip of the needle. This heat allows the interventional radiologist to eliminate a small area of the tumor at a time and decreases the risk of damaging surrounding healthy tissue. After RFA, the dead tumor tissue shrinks and forms a scar.
   
• Trans-Hepatic Arterial Chemo-Embolization (TACE)
  HACE is an effective method of delivering concentrated quantities of chemotherapy directly to a liver tumor. This procedure may also be performed by an interventional radiologist, and involves a catheter inserted into an artery in the patient's groin that directly supplies blood to the liver. Chemotherapy is then delivered via the catheter, along with an occluding agent. The highly concentrated dose of chemotherapy, coupled with the blood vessels being partially blocked with the occluding agent, starves the tumor of its blood supply. This procedure is used to slow or stop the growth of the tumor, and in some cases can cause the tumor to shrink.

Surgical Treatments for Liver and Pancreatic Cancer

• Hepatic Resection
  Hepatic, or liver, resection is a complex surgery which involves removing segments of the patient's liver. The liver is an intricate organ with a dual blood supply, making this type of surgery demanding. Because of the liver's ability to regenerate, surgeons are able to remove up to 75 percent of a patient's liver. This allows large tumors of the liver to be removed, potentially curing many patients. Primary liver cancer and metastatic colorectal cancer are examples of two common tumors that can be removed safely. Hepatocellular cancer is one of the most common liver tumors worldwide. Colorectal cancer affects 150,000 Americans yearly and over 50 percent of patients will ultimately develop metastatic disease to the liver. Survival rates for patients with resection can reach as high as 50 percent at five years, if performed by skilled surgeons. For more information, visit www.livertumor.org.
   
• Hepatic Arterial Infusion
  Hepatic Arterial Infusion (HAI), usually an option for patients with metastatic colon cancer, is a therapy involving the delivery of chemotherapy drugs to the liver through a catheter into the main artery supplying the liver.
   
• Hepatic Artery Infusion Pump Placement
  The placement of a hepatic artery infusion pump into the blood supply of the liver allows chemotherapy medication to be delivered directly into the liver (See illustration). The placement of a pump into the hepatic artery after liver resection has allowed for additional chemotherapy to be delivered after surgery for up to six months. Results of two randomized trials have shown significant improvement in disease-free survival.
   
• Open Surgical Radiofrequency Ablation
  Tumors that cannot be removed surgically can sometimes be eliminated by radiofrequency ablation. This is a new technology that uses electrical energy that is converted into heat, which can be used to burn liver tumors. Cell death and tumor destruction can be achieved without harming the liver. This procedure can be performed either as open or laparoscopic surgery by a skilled surgeon or CT-guided by a skilled radiologist.
   
• Laparoscopic Radiofrequency Ablation
  Laparoscopic radiofrequency ablation is another procedure which applies an alternating current of electrical energy converted into heat, which can be used to burn tumors of the liver. The difference is that only small incisions are made, which limits postoperative pain and allows for quicker recovery for patients. Laparoscopic radiofrequency ablation, unlike other methods, allows surgeons to assess a tumor completely by using ultrasound. By viewing the surrounding organs, it is possible to detect additional tumors, bleeding or potential complications.
   
• Whipple Procedure for Pancreatic and Periampullary Cancer
  The Whipple Procedure is a complex operation which involves removing the head of the pancreas, called the duodenum, and parts of the bile duct. It is most frequently performed for malignancies in the periampullary region, such as pancreatic cancer. This procedure requires the skill of a highly specialized surgeon. After removal of the pancreas and duodenum, a reconstruction must be performed which involves sewing the pancreas, bile duct and stomach to the small intestine. Complications, including pancreatic fistula and delayed gastric emptying, are sometimes encountered. For a description and illustration of the Whipple Procedure, click here.
   
• Minimally Invasive and Advanced Treatment Options for the Liver
  Advances in laparoscopic techniques and equipment have led to an increasing number of procedures performed, with a minimally invasive approach, while maintaining patient safety and superior outcomes.
   
• Minimally Invasive and Advanced Treatment Options for the Pancreas
  Advances in minimally invasive surgical techniques as well as technological development have led to a growth in the number of laparoscopic procedures for pancreatic disease. These procedures are very complex and require specialized training and equipment.

Diagnostic Laparoscopy for Pancreatic Cancer

Patients with suspected or known periampullary disease scheduled for a Whipple procedure typically undergo laparoscopy immediately prior to open exploration. Up to a third of patients with periampullary carcinoma may have metastatic disease not previously identified on pre-operative imaging. In the absence of metastatic disease, the incision is extended for surgical resection of the tumor.

Laparoscopic Distal Pancreatectomy

Advances in minimally invasive surgical techniques have led to a growth in the number of laparoscopic procedures for pancreatic disease. Laparoscopic pancreatic resections have been performed in patients with a variety of diseases as well as certain types of cancers. Depending on the type of pancreatic lesion, the procedure can be performed with and without splenic preservation. During the procedure a laparoscopic ultrasound is performed to confirm the presence of a pancreatic lesion as well as to identify any additional lesions or pancreatic abnormalities. Laparoscopic resection offers several benefits to patients including reduced post-operative pain, a shorter hospital stay, less blood loss, a quicker recovery and improved appearance due to smaller incisions.

Laparoscopic Enucleation of Pancreatic Neuroendocrine Tumors

Neuroendocrine, or islet cell tumors, of the pancreas can vary in size and location in the pancreas. Lesions that are small, less than two centimeters (one inch), and have a favorable location related to the pancreatic duct may be enucleated, “shelled out” thus preserving normal pancreas. If enucleation can not be performed, laparoscopic resection may be considered. The laparoscopic enucleation procedure has similar benefits regarding a short hospital stay, reduced pain and expedited recovery.

Laparoscopic Pseudocyst Drainage

Pseudocysts are contained collections of pancreatic juice which leaked during a bout of acute pancreatitis. If they do not recur spontaneously or become symptomatic they may require surgical drainage. The surgical approach utilized allows “internal drainage” to adjacent abdominal organs, most commonly the stomach, duodenum or small intestine. This allows for decompression of the cyst contents and can relieve symptoms. Typical symptoms caused by enlarged pseudocysts include pain, inability to eat, nausea, vomiting or jaundice.

Laparoscopic Liver Resection

Liver resection is a procedure performed for primary and secondary tumors of the liver. Advances in laparoscopic techniques and equipment have led to an increasing number of procedures performed, with a minimally invasive approach, while maintaining patient safety and superior outcomes. Typical laparoscopic resections include wedge excisions and segmental resections, including left lateral segmentectomy. These procedures can be performed for primary and metastatic lesions to the liver. At the time of laparoscopy, intra-operative ultrasound is performed, which is crucial to defining anatomic landmarks, confirming the presence of a suspected lesion and identifying new, undetected lesions. The minimally invasive approach offers similar benefits of laparoscopy, with less pain, shorter hospital stay, quicker recovery and smaller incisions while maintaining oncologic principles.

Laparoscopic Radiofrequency Ablation (RFA)

RFA is a technique that involves the delivery of a high energy current to a specific area via a radial probe. The internal temperature of the tumor is coagulated to greater than 100ºC. The probe is placed with ultrasound guidance and extends to provide an adequate “burn” margin around the tumor. Laparoscopic ultrasound of the entire liver is performed during the procedure to confirm the intended target lesion(s) and to identify any previously undetected ones. This procedure can be performed for tumors not amenable to resection as well as in concert with resection. As a primary procedure the recovery is expedited with a typical hospital stay of one day.

Laparoscopic Cyst Enucleation and Fenestration

Benign simple cysts are rarely symptomatic. However, with increased size or rapid expansion they can lead to pain, respiratory difficulty and gastrointestinal complaints. Simple cysts can be laparoscopically unroofed, then evacuated relieving the compressive-type symptoms. Biliary cysts, or cystadenomas, are benign but have the potential to become malignant. They can be treated by enucleation or “shelling out” the lesion. This preserves the liver tissue and is often less complex than resection. Location and size of these lesions is important in determining the efficacy of a laparoscopic approach. Benefits of both procedures include a short hospital stay (between one to two days), a faster recovery, decreased pain and smaller incisions.

Please call 410.427.2024 to reach The Hodes Liver and Pancreas Center at St. Joseph Medical Center. We except all major insurance companies.

If you have an appointment, please print out the following form and fill it out. Please bring the completed forms to your appointment.

Consent Forms

• Pancreatic Surgery Consent Form
• Liver Surgery Consent Form

Discharge Instructions

• Postoperative Instructions for Laparoscopic Gallbladder Surgery
• Post Operative Instructions for Laparoscopic and Open Hernia Surgery
• Postoperative Instructions for Liver Resections
• Post Operative Instructions for Pancreatic Surgery

The Hodes Liver and Pancreas Center at St. Joseph is a multidisciplinary team designed to treat patients with complex diseases related to pancreatic cancer, primary liver cancer, metastatic colorectal cancer and bile duct cancer. Patients are typically from Maryland, Delaware, Pennsylvania and Virginia.