Diagnosis & Treatments
The clinic’s team approach to the diagnosis and treatment of liver cancer ensures that every facet of each patient’s condition is fully addressed. The clinic’s diagnostic and treatment algorithms incorporate healthcare professionals from various disciplines, including:
- Medical oncology
- Diagnostic and interventional radiology
- Social work
For each patient, the team focuses on understanding the underlying status of the liver, including the presence or absence of cirrhosis, in the context of the tumor stage. Thus, the team’s approach to staging has two levels of complexity—staging the degree of chronic liver disease and assessing the tumor stage—to enable members of the team to make the right therapeutic decisions. Through discussions at the weekly tumor board meetings, the diagnostic and treatment algorithms are updated to keep pace with evolving technologies and advancements in the field. The potential therapeutic options that are offered through the clinic include:
- Resection (open or laparoscopic)
- Radiofrequency ablation (RFA)
- Transarterial chemoembolization (TACE)
- Intra-arterial radiotherapy (IRT)
- Transarterial drug-eluting beads
- Transarterial radioembolization Y90
- Combination therapy with RFA+Y90
The newest treatment modality, IRT, involves the injection of radioactive microspheres directly into the vascular bed of the liver cancer, which results in emission of internal radioactivity. Under certain circumstances, these liver-directed ablative therapies are combined. With larger lesions, for example, TACE may be followed within 5 to 10 days by RFA in order to maximize the tumor “kill.” RFA is offered either percutaneously (in which needle electrodes are inserted through the skin and into the tumor) or laparoscopically (in which a thin plastic tube containing the electrodes is threaded through a small incision in the skin), depending on whether the percutaneous route is technically achievable.
Liver transplantation may be offered to patients who meet certain staging criteria (called Milan criteria), which include having single tumors less than 5 centimeters in diameter; having multiple tumors (3 or fewer lesions with the largest lesion being no larger than 3 centimeters); and having no vascular invasion. Depending on specific circumstances, transplantation from either living or deceased donors may be offered.
Not all patients seen in the Liver Cancer Clinic have HCC. Patients with other malignant liver tumors, such as from cholangiocarcinoma or metastatic colorectal cancer, also are evaluated and managed by the team. In addition, patients with benign liver tumors are assessed at the clinic. Lastly, patients with underlying liver disease who are in need of abdominal surgery are evaluated by the transplant surgeon.
To learn more about the liver cancer clinic or to refer patients, please call (312) 695-0870.