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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 80 - 90% of all liver cancers. This type of cancer occurs more often in men than women, usually in people 50 to 60 years old. The disease is more common in parts of Africa and Asia than in North or South America and Europe. The cause of liver cancer is usually cirrhosis (scarring of the liver). Cirrhosis may be caused by viral hepatitis, primarily hepatitis B and C, alcohol abuse, hemochromatosis, certain autoimmune diseases of the liver, and other diseases that result in chronic inflammation of the liver. The most common cause for cirrhosis in the United States is alcohol abuse. Symptoms: Abdominal pain or tenderness, particularly in the right-upper quadrant Enlarged abdomen Easy bruising or bleeding Jaundice (a yellow discoloration of the skin and eyes) Signs and tests: Physical examination shows an enlarged, tender liver. A liver biopsy shows hepatocellular carcinoma. Serum alpha fetoprotein may be elevated. There may be a mass shown on abdominal CT scan. A liver scan may indicate an abnormality. Liver enzymes (liver function tests) are elevated. Treatment: Aggressive surgery or liver transplantation may be successful in treating small or slow-growing tumors if they are diagnosed early. Chemotherapy and radiation treatments are not usually effective but may be used to shrink large tumors so that surgery has a greater chance of success. Support Groups: The stress of illness can often be eased by joining a support group with members who share common experiences and problems. See liver disease - support group and cancer - 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 deadly within 3 to 6 months, although this varies greatly. Survival much longer than this occasionally occurs. Complications: Gastrointestinal bleeding Liver failure Spread (metastasis) of the carcinoma Calling your health care provider: Call your health care provider if persistent abdominal pain develops, particularly if there has been a history of any liver disease. Prevention: Preventing and treating viral hepatitis may help reduce risk. Avoid excessive alcohol consumption. Certain patients may benefit from hemochromatosis screening.

Review Date:9/11/2006 Reviewed By:Rita Nanda, M.D., Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.