Liver & Pancreatic Cancer

Liver and Pancreas Surgical Oncology Clinic

The Leavey Cancer Center liver and pancreatic (hepatobiliary) cancer team is comprised of specialists in gastroenterology, medical, surgical and radiation oncology, interventional radiologists and oncology nursing. This team approach for diagnosis and treatment allows patients to benefit from the expertise of several specialized physicians. Each individual plan of care provides the opportunity for minimal adverse effects and maximum long-term, good quality survival.

Liver operations can be extremely difficult. That’s because many of the major blood vessels running to and from the heart pass behind or through the liver. Plus, it tears easily and bleeds profusely when injured. That’s why it’s crucial to have experienced surgeons like those in our Liver and Pancreatic Cancer Program who specialize in this field.

In 2006, Monica had an X-ray for a kidney stone that revealed a shadow on her pancreas. It turned out to be a mass. “Walid Arnaout, MD, Director, Surgical Oncology, used diagrams to thoroughly explain every option available to me.” Fortunately, surgery determined the tumor was benign. “At all times, I had the utmost confidence in Dr. Arnaout and the entire staff. They were caring, efficient, professional and attentive, both in the Cancer Center and in the ICU.”

Early Detection Leads to Promising Outcomes

Liver and pancreatic cancers are seldom found early as they usually do not cause symptoms until the later stages.

Liver Cancer

There are no screening tests for liver cancer, and small tumors are hard to find by physical exams. For those considered at high-risk (cirrhosis, Hepatitis B or C, or family history), a simple blood test (alpha-fetoprotein or AFP) and an abdominal ultrasound provides a reliable and simple method for detecting primary liver cancers. Patients with an elevated AFP and/or abnormal ultrasound require additional diagnostic testing such as a CT of the abdomen or MRI.

Pancreatic Cancer

There are no screening tests for pancreatic cancer. Tests for certain genes in people with a strong family or personal history of pancreatitis, among other conditions, increase the risk of developing pancreatic cancer. A special blood test known as tumor markers (ca19-9) could be an early indicator of pancreatic cancer. However, this test is not specific to pancreatic cancer and can indicate other conditions.

Early detection and determining the precise stage of your cancer is critical to planning the most effective treatment.

Liver cancer detection procedures available at Northridge Hospital include:

• Triphasic CT Scanning - This state-of-the-art device takes pictures inside the body during three different phases as the blood flows through the liver.
• MRI - This modality uses a magnetic field instead of radiation to identify the presence of a tumor. It can also help to determine if a tumor can be surgically removed.
• Ultrasound - Used to determine if the suspected area is a cyst or tumor.
• Biopsy - A small amount of the tissue is removed to be examined more thoroughly.
• Endoscopy & Laparoscopy - Visually examining the area using a lighted tube or camera scope inserted through a small incision.
• Cholangiography - Dye is inserted into the bile ducts within the liver in order to see the ducts more precisely.
• Angiography - Dye outlines the blood vessels showing which ones take blood to the liver cancer. This can help surgeons decide whether the cancer can be removed and, if so, how to best plan the operation.

Surgical Options

For most hepatobiliary cancers, surgery is often the most effective therapy; therefore proper surgical evaluation is an important part of devising a treatment plan. Our surgeons specialize in "liver-sparing" surgical techniques, which means more of the healthy liver is left intact.

Amazingly, the liver is one of the two organs in the human body that has the capacity to regenerate. Up to 80 percent of the liver can be surgically removed and, within several weeks, it will have entirely regenerated itself.

Conventional Liver Procedures

• Open liver resection
• Laparoscopic liver resection
• Resection of bile ducts

In addition to conventional liver resection, our Center provides patients with several minimally invasive customized care plans designed specifically to treat otherwise unresectable tumors. This involves one or more of the following procedures, all of which are aimed at treating the involved part of the liver with minimal side-effects, discomfort and faster recovery time.

Our team of Interventional Radiologists are leaders in image-guided therapies. These procedures require a very small abdominal incision through which the following procedures are performed:

Minimally-invasive Liver Procedures using CT or Ultrasound

• Diagnostic Laparoscopy and Biopsy - A relatively minimal procedure aimed at direct examination of the abdominal cavity to determine if a tumor is resectable, thus avoiding the need for a much more complicated surgery with added pain and discomfort. It will also allow the surgeon to take a biopsy of the tumor to confirm the diagnosis with minimal risk of bleeding or injury to other adjacent organs and structures.
• Hepatic Artery Infusion Pump - This chemotherapy method is designed to improve chemotherapy benefits for liver cancer by increasing the amount of chemotherapy delivered to the site of the tumor. Chemotherapy is dispensed from a specialized infusion system in which a catheter is placed into the hepatic artery to directly deliver the chemotherapy to the liver.
• Hepatic Artery Chemoembolization - Using image guidance the blood supply to the tumor is surgically or mechanically blocked and anticancer drugs are administered directly into the tumor. This allows for a higher concentration of drug to be in contact with the tumor for a longer period of time.
• Radiofrequency Ablation (RFA) - 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.
• Thermal Ablation - Through the aid of a CT scanner for image guidance, the tumor is either destroyed using heat or freezing techniques. This has minimal side-effects and can be very effective in the treatment of small tumors of the liver in patients who are not candidates for a larger, more extensive liver resection.
• Alcohol Ablation - Although rarely used, another way to kill tumor cells is to inject a chemical agent (ethanol) directly into a tumor.

Pancreatic Cancer Procedures

The Whipple Procedure - This very complex operation is the most common type of surgery for cancer of the pancreas. In this procedure, the head of the pancreas is removed along with parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes.

Whipple’s Procedure is a complex operation with the potential for major complications. Therefore, it is best done at a center, like Northridge Hospital, with vast experience in hepatobiliary and pancreatic surgery, and by a surgeon with extensive experience in this field In addition to the surgical treatment options. 

Our Center provides state-of-the-art chemo and radiation therapy for pancreatic cancers as well as several clinical trials in collaboration with major university hospitals in Southern California.