Liver and Pancreas Cancer Treatment
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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.
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 Liver and Pancreas Center have full access to UM 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 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 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 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 & Minimally Invasive Options
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.
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.
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.
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.