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Wake Forest Baptist Approach View Liver Cancer Surgery and Implantation of Infusion Pump Webcast Abdominal Cancer (Including Esophageal, Stomach, Colon, Rectal, Liver, and Pancreatic Cancers) Management of abdominal cancers focuses on preventive measures, early detection and treatment through numerous clinical trials developed locally, regionally and nationally. New drug and radiation therapies, and combined modality treatments, are being explored through these trials. Liver Resection and Implantation of Infusion Pump Liver resection is the gold standard treatment for most patients with primary and metastatic hepatic tumors.  In the past this used to be a formidable surgical procedure with high post-operative morbidity and mortality.  However, increased knowledge of liver segmental anatomy combined with technological advances and improved anesthesia/critical care have markedly decreased the risk and made this a potentially curative option for many patients.  The application of intraoperative ultrasound gives the surgeon detailed real-time information to facilitate the resection and achieve negative margins while decreasing blood loss.  New devices to transect the liver parenchyma have made the procedure safer.  We are currently in the process of developing minimally invasive laparoscopic techniques to remove liver tumors with the potential to speed recovery and shorten hospital stay with similar oncologic outcomes. Wake Forest Baptist has an active program of adjuvant hepatic arterial infusion therapy for patients with hepatic colorectal metastases after resection or ablation of their tumors.  This method of delivery produces a higher concentration of chemotherapy in the remnant liver, which is at risk for recurrence, while minimizing systemic toxicity.  The chemotherapy is delivered via an implantable hepatic pump placed at the time of liver resection or ablation.  We are in collaboration with other centers studying the combination of hepatic intra-arterial chemotherapy combined with new systemic agents which are actively accruing patients.   This multimodality approach has the potential to improve the overall and disease-free survival of patients with hepatic colorectal metastases. Radiofrequency Tumor Ablation Cancer in the liver, whether it is the primary site of the malignancy or metastases from other sites, is notoriously difficult to treat and a major cause of suffering and death. Surgery is frequently not an option because of the size, number or location of the tumors, and chemotherapy can be ineffective.                Radiofrequency tumor ablation is a relatively new treatment option that is only available in a few centers across the country. Using ultrasound to see inside the liver, the doctor guides a needle into the center of the tumor. Radiofrequency energy is passed through the needle, which has a tip resembling a miniature grappling hook, and destroys the tumor with intense heat. Nearby tissue is unharmed, and there are no serious side effects.   Hepatocellular carcinoma Digestive system Liver biopsy Hepatocellular cancer, CT scan Definition: Hepatocellular carcinoma is cancer of the liver. Alternative Names: Primary liver cell carcinoma; Tumor - liver; Liver cancer; Cancer - liver Causes, incidence, and risk factors: Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people ages 50 - 60. The disease is more common in parts of Africa and Asia than in North or South America and Europe. Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver. In most cases, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by: Alcohol abuse (the most common cause in the U.S.) Certain autoimmune diseases of the liver Diseases that cause long-term inflammation of the liver Hepatitis B or C virus infection Too much iron in the body (hemochromatosis) Patients with hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis. Symptoms: Abdominal pain or tenderness, especially in the upper-right part Easy bruising or bleeding Enlarged abdomen Yellow skin or eyes (jaundice) Signs and tests: Physical examination may show an enlarged, tender liver. Tests include: Abdominal CT scan Abdominal ultrasound Liver biopsy Liver enzymes (liver function tests) Liver scan Serum alpha fetoprotein Some high-risk patients may get periodic blood tests and ultrasounds to see whether tumors are developing. Treatment: Aggressive surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early. Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumors so that surgery has a greater chance of success. Sorafenib toslate (Nexavar), an oral medicine that blocks tumor growth, is now approved for patients with advanced hepatocellular carcinoma. Support Groups: You can ease the stress of illness by joining a support group with members who share common experiences and problems. See: Cancer - support group Liver disease - support group Expectations (prognosis): The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months. Complications: Gastrointestinal bleeding Liver failure Spread (metastasis) of the carcinoma Calling your health care provider: Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease. Prevention: Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future. Avoid drinking excessive amounts of alcohol. Certain patients may benefit from screening for hemochromatosis. If you have chronic hepatitis or known cirrhosis, periodic screening with liver ultrasound or measurement of blood alpha fetoprotein levels may help detect this cancer early. References: National Cancer Institute. Adult primary liver cancer treatment PDQ. Updated May 22, 2009. Roberts LR. Liver and biliary tract tumors. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 206.

Review Date:8/9/2009 Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.