Interventional Treatment of Liver and Pancreatic Cancer

What is Liver and Pancreatic Cancer | Diagnosing Liver and Pancreatic Cancer | Interventional Treatment of Liver Cancer
Minimally Invasive and Advanced Treatment Options for Pancreas | Minimally Invasive and Advanced Treatment Options for the Liver
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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.

Chemotherapy

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 Hodes Comprehensive Liver and Pancreas Center have full access to 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 an 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 a 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 a scar. Click here to see images of the procedure.                                                                                 
  
• 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 for Liver and Pancreatic Cancer:

• Hepatic Resection
  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. For more information, visit www.livertumor.org.
  
• 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.
  
• Hepatic Artery Infusion Pump Placement
  The placement of a hepatic artery infusion pump into the blood supply of the liver allows chemotherapy medication to be delivered directly into the liver (See illustration). The placement of a pump into the hepatic artery after liver resection has allowed for additional chemotherapy to be delivered after surgery for up to six months. Results of two randomized trials have shown significant improvement in disease-free survival.
  
• 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. For a description and illustration of the Whipple Procedure, click here.
  

• 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, click here. 

• 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, click here.