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Recent advances in liver cancer care seek to address the rising incidence of liver cancer, which has steadily increased over the past three decades. Once blood tests reveal elevated AFP levels or ultrasound shows a lesion in the liver, patients should undergo further evaluation to determine if liver cancer is present and to assess for size and number of tumors. When determining treatment options for hepatocellular carcinoma (HCC), our team evaluates the lesion imaging and lab results, along with the patienta€™s age, liver function, and overall health, to recommend appropriate treatment options.
California Pacific Medical Centera€™s San Francisco Center for Liver Disease Program offers comprehensive specialty care for adult end-stage liver disease and liver cancer.
California Pacific Medical Center, part of the Sutter HealthOpens new window network, offers specialized care in liver disease and liver transplant. The liver is the largest organ inside the body, and its functions are essential for the digestion of food.
The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals.
The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Because the liver is made up of several different types of cells, several types of tumors can form there. At California Pacific Medical Center, our Liver Cancer Program sees individuals with both hepatocellular carcinoma (primary liver cancer) and metastatic liver lesions. This preoperative evaluation includes diagnosis and localization of the lesion, staging, and a determination of treatment options. We emphasize ongoing communication with referring physicians and incorporate them into the decision process of their patientsa€™ medical management.
The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion.
Some of these are benign (noncancerous) and some are cancerous and can spread to other parts of the body (metastasize). Our medical-surgical team, comprising an oncologist, hepatologist, radiologist, and surgeon, works together to evaluate each patient and determine optimal liver cancer treatment. California Pacific Medical Center uses a variety of techniques to help determine the location and stage of HCC. Following treatment, we follow up our care with an organized discharge report to the referring physician. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells travelling in the bloodstream. Some start as a single tumor that spreads to other parts of the liver as the disease develops. Current treatment options include surgical removal of tumors, liver transplantation, application of chemotherapy and radiation into the liver, and systemic chemotherapy treatments.

Surgical resection involves the removal of one or more sections of the liver in which a tumor(s) exists. For patients requiring hospitalization, we have a dedicated critical care liver unit, a hospitalist who specializes in liver disease, physician assistants, on-call anesthesia staff, and a specialized O.R. AFP is a protein produced by the liver, and an elevated level can indicate tumor growth, though some patients with liver cancer have normal AFP levels.
In some cases, a liver biopsy is required to determine the type of liver tumor.Diagnostic Imaging At California Pacific, liver imaging may include a four-phase computed tomography (CT), including spiral CT scans obtained during hepatic arterial and portal venous phases following intravenous contrast administration, or state-of-the-art magnetic resonance imaging (MRI). Typically, surgeons can remove up to 70% of a cancerous liver (if there is no or mild fibrosis) and it will regenerate in about two to six weeks following surgery. For patients with abnormalities in these tests, an evaluation with contrast-enhanced CT or MRI is recommended to determine if cancer is present.
These techniques can accurately demonstrate the number of primary tumors within the liver and their relationship to vascular structures.
At California Pacific, our focus is on providing experienced, personalized care for all patients.Our Cancer Care Navigation Service provides individuals and families assistance with appointment scheduling, patient education, and support service referral. For surgical purposes, the liver is divided into eight segments (see illustration), based on vascular inflow and bile duct drainage.
Weight loss is common and sometimes patients have episodes of severe pain, fever, and nausea. FDG positron emission tomography (PET) is occasionally helpful in characterizing atypical hepatic masses as well as in detecting extrahepatic malignancy.Metastatic Work-UpPatients with HCC require a metastatic work-up to determine if cancer has spread to surrounding tissue.
Patient education and support is a priority at our center, and patients and their families have access to a weekly patient education class and monthly support group.
The liver's eight-segment divisionDuring resection, the surgeon first uses ultrasound to determine the tumora€™s proximity to hepatic structures.
With the use of new treatment methods and ongoing clinical research, patients now have more options than ever for treating liver cancer. After treatment, or while awaiting liver transplant, patients should continue to be staged every three to six months with chest and abdomen CT and bone scans. The surgeona€™s goal is to remove the tumor(s) and as little liver as possible, while ensuring a margin free of tumor.
For patients who may not be eligible for the therapies outlined above, California Pacific has an active Hepatology and Gastroenterology Research Program that is involved in new, investigational techniques.
If, following this staging, there is a question of extrahepatic disease, physicians may offer patients a diagnostic laparoscopy or endoscopic ultrasound (EUS). Using vascular occlusion and isolation techniques that cut off blood flow to the liver during surgery, it is now possible to perform major hepatic resections with minimal blood loss. We welcome patients who are interested in pursuing clinical trials for these new therapies.

As with all resections, postoperative complications can occur from the cut edge of the liver.
Most of these complications can be treated nonoperatively.Liver Transplantation While a liver transplant represents an excellent cure for most patients with HCC, the limited organ supply makes this option unattainable for some. Patients who may benefit from liver transplantation include those with small, unresectable HCC and cirrhosis.
The United Network for Organ Sharing (UNOS) eligibility criteria for transplantation are the presence of a single hepatoma 5 cm or less in diameter, or three or fewer tumor nodules, each 3 cm or less in diameter. These criteria can elevate a patienta€™s status on the transplant list.While waiting for transplantation due to HCC, patients should be monitored with serial abdominal imaging to evaluate for tumor growth. The five-year survival with transplant is more than 70% with a risk of tumor recurrence of less than 10%.AblationPatients who are not candidates for transplant or resection due to inadequate liver reserve, large or multiple lesions in multiple lobes, or cirrhosis may benefit from minimally invasive ablation therapy.
This therapy uses extreme heat to destroy liver tumors.The ideal patient for ablation generally has no more than three lesions that are no greater than 5 cm in size. Ablation delivers radiofrequency energy to the tumor, heating it to temperatures above 113A? F and thereby destroying the lesion.
This technique can be used via computed tomography (CT) by an interventional radiologist, or using laparoscopic or open surgery techniques with ultrasound guidance by a surgeon, depending on the lesiona€™s size and location.Transarterial Therapy Patients with HCC and cirrhosis are frequently treated with transarterial therapy, a technique that delivers treatments directly into the liver. To gain access to the liver, physicians first make a small incision in the patienta€™s leg and then place a long catheter into the femoral artery.
Guided by fluoroscopy (an X-ray imaging technique), the physician then moves the catheter up through the blood vessels to the hepatic artery, one of two blood vessels that feed the liver.
In this therapy, Lipiodola€” a thick, oily substancea€” is mixed with chemotherapy (platinol, mitomycin-c, and adriamycin) and injected under radiological guidance directly into the artery supplying the tumor. The Lipiodol acts to contain the chemotherapy within the tumor and blocks further blood flow to the tumor. Blocking the flow of blood to the cancer helps to kill the cancer cells, as it cuts off the tumora€™s food and oxygen supply.Transarterial Chemoembolization (TACE) with Doxorubicin-filled Beads - Doxorubicin is a chemotherapeutic agent that helps stop the growth of tumor cells. In this therapy, doxorubicin- filled beads are delivered directly to the liver, which releases chemotherapy slowly over time and also blocks the blood flow to the tumor. With doxorubicin-filled beads, the delivery of chemotherapy-filled beads prolongs the dwell time of the chemotherapeutic agent and enhances drug delivery to liver tumors 10- to 100fold compared to systemic infusion.Radioactive Yttrium Beads - This therapy uses radioactive yttrium beads delivered via a catheter into the hepatic artery.
The beads are quite small and do not occlude the blood flow, which allows access to the tumor again if further treatment is needed.
This therapy can be used in larger tumors than the above therapies, and may also be used if the portal vein is occluded since the arterial flow to the liver is not occluded.

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