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When a cancer starts in the liver, it is most commonly a type of cancer known as hepatocellular carcinoma (HCC). Unfortunately, this is the 3rd most frequent cause of cancer in the United States. Liver cancer is a highly treatable form of cancer and can be controlled with different types of procedures performed by interventional radiologist and special medicines. In some patients with early cancer, it can be cured with a liver transplant.
The reason patient get liver cancer is cirrhosis. As chronic damage happens in the liver that leads to cirrhosis, it also causes changes in the cells that lead to cancer. In the United States, the most common causes of cirrhosis that can lead to liver cancer are hepatitis C, hepatitis B and fatty liver.
Unfortunately, liver cancer does not cause many symptoms until it is very advanced. In those cases, it may cause pain on the right side or yellowing of the eyes and skin or jaundice. Since liver cancer is highly treatable and there are no warning signs, it is recommended that patients with advanced liver disease or cirrhosis get a picture of the liver with ultrasound, MRI or CT every 6 months. Doctors know that finding a liver tumor early can save lives.
Once it is suspected that a patient has a liver tumor, a special MRI or CT scan is done to understand the quality, number and size of the tumors. There are also blood tests that can be done that sometimes detect liver cancer as well. The most common blood test used is the alpha-fetoprotein (AFP). All patients with cancer of the liver should be seen by a hepatologist and then referred to a special team of doctors that review the patient’s case together known as a tumor board. This expert panel of doctors includes liver doctors, liver surgeons, cancer doctors, and radiologists. The team will evaluate the patient’s case together and come up with an expert recommendation about the plan of care.
Yes, there are many treatment options for liver cancer. The best way to way to decide on a treatment plan is to review the patient’s case at tumor board. Most often, the first line treatment is to perform a locoregional therapy. A locoregional treatment is when a special kind of doctor known as an interventional radiologist delivers a treatment to the cancer either by bringing the chemotherapy right to it or burns it with microwave. The medicines that these doctors use include chemotherapy or radiation therapy, known as a TACE or Y90.
Some patients cannot get locoregional therapy and they are better candidates for medicines like sorafenib, regorafenib, or nivoluminab. Occassionally, there are limited options for a patient, and in those cases we offer clinical trials.
On the other hand, if the tumors are able to be controlled and are not too big the patient may be a candidate for liver transplantation, which is a cure for cancer.
If you have liver cancer, we are equipped to quickly evaluate your case with state of the art technology in a multidisciplinary approach. Liver cancer is highly treatable and even curable. If you don’t have liver cancer but think you are at risk, then ask.
Hepatitis B is a virus that can lead to liver damage, cancer and even death. Hepatitis B can be transmitted from birth or person-to-person, for example from sex or sharing needles.
If you are concerned that you may have hepatitis B you may be referred to a hepatologist. The first sign might be flu-like or from yellowing of the skin and eyes (jaundice). In some cases no symptoms might be noted. If the disease has been left untreated for many years, cirrhosis can develop.
Yes blood tests are recommended and your doctor may also recommend a liver biopsy. All patients with hepatitis B infection should be assessed for their risk of liver cancer. Some may need an ultrasound of the liver every 6 months.
A liver biopsy is the best test to determine the amount of damage to the liver. When examined under a microscope, the biopsy can be graded for the amount of scar tissue. Stage 1 and 2 indicates mild amounts of scar tissue. The highest amount of scar tissue is stage 4, which indicates cirrhosis of the liver. Cirrhosis is a very serious medical diagnosis. In some cases we can determine the stage of liver damage with a picture of the liver known as the fibroscan.
Medicines for hepatitis B are available in pill form or shots. Your doctor can discuss which are right for you. Additionally, patients with hepatitis B should avoid alcohol and receive vaccinations for hepatitis A. Sexual partners and other household members should receive the hepatitis B vaccine.
What is Hepatitis C?
Hepatitis C is a viral infection that affects the liver. We believe that 5 million Americans have been exposed the virus through blood transfusions before 1992, tattoos and sharing needles. There may be no symptoms of hepatitis C, and patient would not know they had it unless they were specifically checked for it.
Who should get tested for Hepatitis C?
The virus is spread through contact or contamination of blood. All persons born between 1945 and 1965 should get checked since they have the highest risk. Anyone who had a blood transfusion before 1992, received medical care in Mexico, has a tattoo or history of sharing needles should get checked. In some cases, we do not know how a person was infected.
How is Hepatitis C diagnosed?
Hepatitis C is first suspected if a patient has a positive hepatitis C antibody. This may be checked if liver tests are abnormal or if a patient has risk for HCV infection. The test is confirmed by measuring the amount of virus in the blood. This test is known as the HCV RNA. The next important test to know is the genotype of the virus, and there are 6 different strains of the virus. The most common genotype in the US is genotype 1a. An additional test known as “resistance testing” can be done to see how the new Hepatitis C medications will work best against the patient’s virus.
How can my doctor tell how much damage has been done to my liver?
A liver biopsy is the best test to determine the amount of damage to my liver. When examined under a microscope, the biopsy can be graded for the amount of scar tissue. Stage 1 and 2 indicates mild amounts of scar tissue. The highest amount of scar tissue is stage 4, which indicates cirrhosis of the liver. Cirrhosis is a very serious medical diagnosis. In some cases we can determine the stage of liver damage with a picture of the liver known as the fibroscan.
Can Hepatitis C be treated?
Yes, Hepatitis C is highly treatable! There are a number of FDA approved medications for hepatitis C and none of them require injections or interferon. New hepatitis C medications are all-oral and have low side effects with short durations of therapy. After taking these medications, more than 95% of people are cured for life.
Patients, who have recovered from pancreatitis due to gallstones, may need to have their gallbladder removed surgically. The procedure is called a cholecystectomy, and can be done with a camera and small incisions (laparoscopic) or through a larger cut (open). During the operation the cystic duct and artery have to be clipped and cut. The gallbladder will be separated from the liver, and removed.
Patients can usually leave the hospital the day after the operation after laparoscopic surgery. They able to eat a regular diet, and will be given medication for pain at their incision (cut).
A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach.
This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.
If surgery is part of your treatment plan, your doctor will likely suggest one of two surgical procedures:
During surgery, the head of the pancreas, the gallbladder, the first part of the bowel called the duodenum, part of the stomach and bile duct are removed. New connections called “anastomoses” are made between the bile duct and the bowel, the pancreas and the bowel and the stomach and the bowel. These new connections are necessary for you to eat and digest your food.
The body or tail of the pancreas and the spleen are removed. No new connections or “anastomoses” are made. You will need vaccinations before surgery, because your spleen usually eliminates certain types of bacteria.
If your tumor grows into the portal vein, which is the main blood vessel to liver passing behind the pancreas, your surgeon might have to remove a small piece, when removing a tumor. The portal vein can be repaired.
A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:
Usually once a week
The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.
Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.
Depending on the size and location of your tumor, you may need a “wedge resection” (or removal of a small part of your liver) or a “lobectomy” (or removal of a large part of your liver). In most patients, it is safe to remove up to 60-80% of the liver because the liver can regenerate! Liver surgery can be performed using an open incision or sometimes Laparoscopically.
In order to safely get to your liver, your surgeon typically makes incisions under the ribcage on the right side. Sometimes it is necessary to make a “Chevron” or “Mercedes-Benz” incision if your tumor is in a hard to reach spot!
Since these surgeries are performed “minimally invasively,” your incisions are oftentimes smaller and located lower in your abdomen. You may have one incision that is larger than the others because that is used to remove the tumor specimen from the body.
After your operation, you will need to recover in the hospital anywhere between 2-7 days depending on the extent of your operation. During this time we will repeatedly encourage and assist you with walking and deep breathing exercises.
Some patients will be transferred immediately to the Intensive Care Unit (ICU) for recovery. Usually after 1-2 days they will be transferred to the inpatient floor to continue the recovery process.
All rooms at St Vincent are private and you will not share your room with another patient.
Yes, we encourage family to visit and keep patients company during the day. Family are not discouraged to stay overnight, however, so that patients can receive adequate sleep.
Yes, once approved by your care team it is allowed and encouraged to bring home-cooked meals. However, if you are on a special restricted diet (for example, low sodium), we ask that family do not bring food from home.
Unfortunately since smoking has been shown to inhibit wound healing, we prohibit smoking in our patients. Additionally, because of the fire danger with smoking and oxygen cannulas (which most of our patients have!) any smoking is prohibited. We will prescribe you nicotine patches or gum when appropriate.
All patients will have their pain controlled after the operation. This is typically achieved by using a combination of oral medications, epidural pumps, and patient controlled anesthesia (PCA) pumps. Be aware though: narcotic medications can cause constipation and if your bowels are not moving after surgery, then sometimes it is necessary to decrease the amount of pain medications we give you.
The goals for discharge include:
Sometimes patients will require the assistance of physical therapy at home or may even need to be discharged to a rehabilitation facility. Our social workers will work with you to arrange this care.
Once you are cleared to go home, the safest option for you is to leave the hospital. Because the hospital is full of other sick patients, you have a greater chance of exposure the longer you stay.
On the day of discharge, a member of your care team will review your discharge paperwork, medications, and follow-up instructions with you and your family. In the case of emergencies, please call (213) 484-5551. If you feel the emergency is life-threatening, please call 911!
Typically, stitches and medical “Super-Glue” will be used to close your incisions, and there is no need to take out the stitches afterward because they will dissolve. If you have surgical staples, these will need to be removed by your doctor approximately 5-15 days after the surgery. Taking out the staples is painless for most patients!
surgical staples stitch removal
We prefer that you shower after surgery, and that can be done as soon as the first day after surgery! We recommend against baths, jacuzzis, or submerged water. You do not need to cover your incision when you shower.
It will be safe to resume full exercise by about six weeks postoperatively. Between 1-6 weeks you are at high risk for a hernia developing in your incision, so please do not lift anything heavy (anything more than a milk jug!) Please discuss with your doctor before resuming activity.
Driving a car or operating heavy machinery is safe when you are no longer taking pain medications and are able to have appropriate reaction times.
Drinking alcohol after liver surgery is not advised, because your liver is still healing.
Liver ablation is an effective way of treating liver tumors. During an ablation, a needle is guided into the tumor at which point energy is applied to heat tumors to the point where the tumor is destroyed. After the tissue is destroyed, your body will reabsorb the cellular material. Ablations can be performed using an abdominal surgical incision (“open surgery”) or laparoscopic “keyhole” surgery.
Ultrasound to locate the tumor Before After
Most ablations are performed laparoscopically (via “keyhole” surgery).
Sometimes, depending on the location of the tumor, the ablation will
need to be performed using an “open” incision.
Typically, stitches and medical “Super-Glue” will be used to close your incisions, and there is no need to take out the stitches afterward because they will dissolve. If you have surgical staples, these will need to be removed by your doctor approximately 5-15 days after the surgery. Taking out the staples is painless for most patients!
We prefer that you shower after ablation, and that can be done as soon as the first day after ablation! We recommend against baths, jacuzzis, or submerged water. You do not need to cover your incision when you shower.
It will be safe to resume full exercise by about six weeks postoperatively. Between 1-6 weeks you are at high risk for a hernia developing in your incision, so please do not lift anything heavy (anything more than a milk jug!) Please discuss with your doctor before resuming activity.
After your operation, you will need to recover in the hospital anywhere between 1-3 days depending on the extent of your ablation. During this time, we will repeatedly encourage and assist you with walking and deep breathing exercises.
Patients are typically send to the Med/Surg unit after the procedure to continue the recovery process.
All rooms at St Vincent are private and you will not share your room with another patient (???? Don’t know if this is correct)
Yes, we encourage family to visit and keep patients company during the day. Family are not discouraged to stay overnight, however, so that patients can receive adequate sleep.
Yes, once approved by your care team it is allowed and encouraged to bring home-cooked meals. However, if you are on a special restricted diet (for example, low sodium), we ask that family do not bring food from home.
Unfortunately since smoking has been shown to inhibit wound healing, we prohibit smoking in our patients. Additionally, because of the fire danger with smoking and oxygen cannulas (which most of our patients have!) any smoking is prohibited. We will prescribe you nicotine patches or gum when appropriate.
All patients will have their pain controlled after the operation. This is typically achieved by using a combination of oral medications, epidural pumps, and patient controlled anesthesia (PCA) pumps. Be aware though: narcotic medications can cause constipation and if your bowels are not moving after surgery, then sometimes it is necessary to decrease the amount of pain medications we give you.
The goals for discharge include:
Sometimes patients will require the assistance of physical therapy at home or may even need to be discharged to a rehabilitation facility. Our social workers will work with you to arrange this care.
Once you are cleared to go home, the safest option for you is to leave the hospital. Because the hospital is full of other sick patients, you have a greater chance of exposure the longer you stay.
On the day of discharge, a member of your care team will review your discharge paperwork, medications, and follow-up instructions with you and your family. In the case you Have questions or would like to Speak to a member of the team, Please call 213-484-5551. If you feel the emergency is life-threatening, please call 911!
Driving a car or operating heavy machinery is safe when you are no longer taking pain medications and are able to have appropriate reaction times.
Drinking alcohol after liver ablation is not advised, because your liver is still healing.