Early detection and diagnosis of pancreatic and hepatobiliary (liver, bile ducts, or gallbladder) cancers are often challenging because of vague initial symptoms and the location of the pancreas and hepatobiliary system can make cancer hard to detect. Prompt and accurate diagnosis requires engaging highly skilled specialists who have access to the range of diagnostic tools and treatment options necessary to optimize patient outcomes.

Within the University of Maryland Medical System (UMMS), this specialized, multidisciplinary care for pancreatic and hepatobiliary cancer is available at UM Greenebaum Comprehensive Cancer Center (UMGCCC), UM Baltimore Washington Medical Center, and UM St. Joseph Medical Center. In early 2024, UM Capital Region Medical Center will open a regional cancer center to serve Prince George's County and surrounding areas. Not only will the center provide comprehensive diagnostic, treatment and support services, it will be affiliated with UMGCCC.

"Our network of cancer centers within UMMS deliver the highest quality of patient-centered multi-disciplinary hepatobiliary pancreatic comprehensive care for the communities we serve," said Nader Hanna, MD, surgical oncologist and professor of surgery at the University of Maryland School of Medicine. "It comes down to teamwork and interpersonal accountability, which are core strengths. Our ability to work collaboratively enables us to be nimble with patient care, quickly moving forward with treatment plans."

Diagnostic and Interventional Options

UMMS' hepatobiliary pancreatic cancer programs offer advanced diagnostic and interventional capabilities. Our interventional radiologists play in integral role in providing minimally invasive diagnostic and treatment options, reducing pain. Diagnosis will typically begin with a thorough medical history and physical examination to assess symptoms and risk factors. Ultrasound, CT and MRI are commonly used to visualize the affected organs and detect any abnormalities. Additionally, blood tests may be performed to evaluate liver function and detect signs of a tumor. In some cases, a tissue biopsy may be necessary for definitive diagnosis and determination of the cancer type.

In addition to the above diagnostic tools, we use endoscopic ultrasound, which gives specialists access to difficult-to-reach areas. It is useful for diagnosis, in terms of visualization and sampling, as well as for therapy. Interventions include nerve blocks for pain management, draining fluid collection, and lumen-opposing metal stents. Endoscopic retrograde cholangiopancreatography (known as ERCP) combines endoscopy and fluoroscopy to enable interventions in the bile duct and the pancreas, mucosal resection, and radiofrequency ablation for Barrett's esophagus, among other procedures.

"The advanced diagnostic capabilities we have available give the team more detailed information about the patient's cancer than has been possible before. The technological sophistication and fellowship-trained expertise in therapeutic endoscopy we offer gives patients the best chance of a successful outcome," said medical oncologist, Kimberly Schlesinger, MD.

Surgical Expertise

To optimize outcomes, we present each patient’s case to our multidisciplinary tumor board at each center. With all the relevant specialists at the table, spanning medical oncology, radiation oncology, GI, surgery, pathology, and others, we can create comprehensive treatment plans designed for each patient's specific tumor.

Our multidisciplinary team provides the most advanced treatments available, from complete or partial surgical removal to systemic, combination therapies to regional, targeted treatment options. Specialists consult weekly to discuss each patient’s treatment plan and progress.

Surgical approaches include open resection as well as a minimally invasive, robotic-assisted option. "We are experts in the Whipple surgery, to include venous reconstruction," said hepatobiliary and pancreatic surgeon Richard Mackey, MD.

Other Treatment Options

The team works hand-in-hand with medical and radiation oncology to coordinate chemotherapy before or after surgery as well as interventional radiology procedures like chemo embolization for liver tumors. The University of Maryland Medical Center is one of the most experienced radioembolization centers in the country. Among our other advanced capabilities are selective internal radiation therapy (SIRT), intra-biliary brachytherapy, robotic-assisted liver surgery, and hyperthermic intraperitoneal chemotherapy (HIPEC), and deep thermal therapy that can be performed in conjunction with radiation therapy. The UMMS network of cancer centers also offer patients access to proton therapy through our partnership with the Maryland Proton Treatment Center. Proton beam therapy is a highly-conformal type of radiation therapy which may help reduce the risk of side effects in some cases, and also allow for re-irradiation when traditional radiation therapy cannot be repeated.

Coordinated Care

In addition to subspecialty interventional expertise and depth of the surgical team, each center brings together nutrition, genetic counseling, pathology, surgery, radiation oncology, medical oncology, wellness and support, research, and others to develop thoughtful treatment plans.

As a part of an of an academic health system, innovations on the horizon, including next-generation sequencing and tumor profiling, are able to transition from the research lab to the bedside quickly. Each center is participating in several ongoing clinical trials, and patients have access to the full range of available trials nationwide through UMGCCC.

For more information or to refer a patient to the hepatobiliary pancreatic cancer program, connect with a specialist at UM Greenebaum Comprehensive Cancer Center, UM Baltimore Washington Medical Center, or UM St. Joseph Medical Center.