The Liver Cancer Program at Smilow Cancer Hospital offers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, when treatment is optimal, and to applying the best treatment options for our patients, as well as to discovering new, more effective treatments.
The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are diagnosed each year in the United States. While the incidence is rising, new surgical, interventional, and medical treatments are being added to our therapeutic armamentarium and are available to our patients. For some patients, these treatments can cure their disease, while for others, liver transplantation may be the solution. After treatment, our team of hepatologists provides continued care to manage the underlying liver disease, preserve liver function, monitor for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply systemic cancer treatment for those in need, as well as access to innovative medications through clinical trials.
To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital has assembled a dedicated group of specialists, including hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our guiding principle is to personalize and adapt care to the changing needs of the patient.
Clinical trials are also available options for patients with advanced disease, using new ablation treatment, new targeted agents, and combinations of treatments to target specific intracellular mechanisms of the liver cancer.
The first team you will meet after being referred to the program will likely be our dedicated hepatologists. Liver cancer is almost always associated with chronic liver diseases of variable severity and with a number of risk factors that must be addressed to block the progression of liver disease and to prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the function of the liver before and during the treatment. Hepatologists will assess liver function, address risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All hepatologists working in the Liver Cancer Program are certified transplant hepatologists. If the patient is deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work with the patient and the family.
Surgical Oncology and Transplant
Treatment options for liver cancer can often be complex due to underlying liver function, extent, and location of the tumor, and the overall health of the patient. Surgery often provides the best survival outcomes through resection (removal of the tumor) or liver transplantation and should only be done by skilled and experienced surgeons such as those in our Program. Our surgical teams provide unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach is tailored to each individual patient. Our teams offer the entire spectrum of surgical care including complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier.
For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery either because of the location of the tumors or because the liver has too much disease, liver transplantation can provide definitive cure for both the cancer and the advanced liver disease that frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor related transplants. Once the patient is actively listed, our transplant hepatology team will provide comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to control the progression of the tumor during the waiting time in the transplant list.
The Interventional Oncology Program at Smilow Cancer Hospital provides additional treatment options for personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver cancer can in fact benefit from a liver directed treatment approach. Interventional Oncology provides definitive or palliative treatment using targeted, minimally invasive procedures performed under precision image-guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for transplant. These are some of the treatments performed, but the options available are more extensive:
Transarterial chemoembolization (TACE): delivers combined chemotherapy with embolization through a catheter directly to the tumor and is the most widely used primary treatment for HCC not amenable to curative treatment by excision or ablation.
Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible or advisable. Ablation can be performed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.
IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to induce precision targeted cancer death, while minimizing surrounding tissue damage in the liver.
Radioembolization (Y90): a minimally invasive procedure that combines embolization and radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor.
Portal Vein Embolization (PVE): a liver regeneration technique that is performed before a liver resection to increase the size of the segment that will remain after surgery.
Our medical oncology team provides experience and knowledge of innovative treatment options and investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however there are now several options for targeted biologic therapies (a special type of oncologic therapy that targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a treatment that helps the body use its own immune system to find and destroy cancer cells). Clinical trials investigating immunotherapy combinations, and molecular targeted therapies are also available.
Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at Smilow Cancer Hospital and need radiation oncology can feel confident that they are receiving the highest quality care from the most experienced team of radiation oncologists in Connecticut. Some of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in less radiation delivered to surrounding tissue and fewer side effects.
Liver pathologists are an integral part of our team and of the liver tumor board and often help with difficult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of common and rare liver diseases. Furthermore, the Department of Pathology offers in depth analysis of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments.
Liver imaging is a major component of our diagnostic armamentarium and requires specialized technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver scan provides important ancillary information including liver volume, architecture, presence of portal hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation of iron, etc. For this reason, for all imaging performed at another institution, we require a second interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For selected cases, contrast-enhanced liver ultrasound is also available.
Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best medical care available and a network of supportive care services. Advanced practice nurses with dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients throughout the continuum of their illness. Patients and their families are also provided with access to social workers to ensure psychosocial support during their treatment. Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.
For more information or to schedule an appointment with the Liver Cancer Program, please call