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Clinical Services
Primary liver cancer is a potentially deadly disease caused by malignancy of the liver cells or bile ducts in the liver. Hepatocellular cancer, or 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, liver cancer may be caused by a tumor called hepatoblastoma. Secondary liver cancer is caused by spread (metastases) to the liver from other cancers in the body. The most common type of cancer that spreads to the liver stems from the colon, but virtually any cancer can potentially spread to the liver.
Primary liver cancer has been growing in importance in the United States, unlike other cancers, which have been decreasing in incidence. Many factors have contributed to this trend, but the increase in liver cancer is largely attributed to hepatitis C virus infection, which over many years can cause both cirrhosis (liver scarring) and liver cancer.
Although hepatitis C is an important factor leading to liver cancer, hepatitis B virus is actually responsible for more cases of liver cancer worldwide. Patients from some parts of the world (especially Sub-Saharan Africa, China, and Southeast Asia) may be lifelong carriers of hepatitis B, which can cause liver cancer.
Diagnosis of Liver Cancer
With modern screening guidelines, patients at higher risk for liver cancer are advised to undergo (at the very least) annual ultrasound examination of the liver and a blood test called Alpha Fetoprotein (AFP), which is sometimes elevated in liver cancer. Most cancer in the liver, either primary or secondary, results in a tumor ("mass" or "lesion") to form in the liver. Tumors can be single or multiple and can be located in different parts (segments) of the liver. The cancer stage depends on the size of the tumor, the number of tumors, whether the tumor is confined to the liver, and whether the tumor invades major blood vessels (arteries and veins) in the liver.
Tumors over 2 cm can almost always be seen on imaging tests such as ultrasound, CT, or MRI. Smaller tumors less than 1 cm in diameter may be difficult to see. If liver cancer is suspected, imaging exams will most certainly be required (and in some cases multiple tests) to help confirm the diagnosis. Biopsy is sometimes but not always used to confirm diagnosis of suspected liver cancer.
Comprehensive Treatment of Liver Cancer
Liver cancer can be a fatal disease if caught in later stages, but fortunately many potentially curative treatment options are available for patients with earlier 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 all options for liver cancer that are available at the Montefiore-Einstein Liver Center.
Because of the variety of different treatment options and the usual presence of underlying liver disease in most patients with liver cancer, it is important that patients with liver cancer be evaluated at a specialized center that has a comprehensive multidisciplinary care team dedicated to liver cancer. Not all treatments are appropriate for every patient, and in many cases, combinations of treatments are used rather than a single type of therapy, so that the care plan that is constructed must be individualized in each case.
Treatment Planning at the Montefiore-Einstein Liver Center
At the Montefiore-Einstein Liver Center, all liver cancer patients are evaluated and discussed with a team that includes a hepatobiliary surgeon (liver surgeon), a hepatologist (liver medicine doctor), a liver medical oncologist, a radiologist, and a radiation oncologist (specialist in radiotherapy). Additionally, we offer psychosocial support services, nutrition support services, and financial counseling. Each case is reviewed at a weekly liver cancer review conference, where new treatment plans and progress on current patients can be discussed. In this way, patients and referring doctors are assured a thorough review of all available options has been performed at a state-of-the-art Center.
