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Liver Cancer

Liver Cancer starts in the cells of the liver. There are two kinds of liver cancer; primary liver cancer, which starts in the tissue of the liver. The other type is secondary (or metastatic) liver cancer, typically starts in another area of the body and moves into the liver.

Our team of experts includes hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists and nurses who collaborate to create a comprehensive care plan.

The team works in partnership with Yale Liver Center and the Yale Cancer Center to give patients access to modern techniques and technology to diagnose and treat liver cancer. Offering a variety of treatment options using advanced therapies, including state-of-the-art genomic profiling, our team provides the appropriate treatment to meet the individualized needs of each patient, while focusing on their quality of life. We understand the importance of clinical trials as we continually strive to provide our patients with the most current therapies.

What to expect

The first team you will meet after being referred to the program will 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 treatments depends on the function of the liver before and during the treatment. Hepatologists will see the patients, assess liver function, address the risk factors, 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 hepatologist team 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.

Symptoms

We emphasize the importance of diagnosing liver cancer early, when treatment is optimal. It is important that patients with risk factors for liver disease (viral hepatitis B and C, liver cirrhosis, excessive drinking, smoking, obesity, type 2 diabetes, etc.) discuss with their physicians the most appropriate tests, screening and surveillance. Often liver cancer is asymptomatic and symptoms may appear late in the disease.

Symptoms of liver cancer are non-specific and are similar to those of the underlaying liver disease. These symptoms may include:

  • Dark-colored urine
  • Fatigue
  • Itching
  • Jaundice (yellowing of skin or eyes)
  • Loss of appetite
  • Swollen abdomen
  • Unexplained weight loss

Diagnosis

After a thorough exam, other tests may be performed to confirm the diagnosis of liver cancer and to determine its stage. These tests include:

  • Blood tests, including biomarkers
  • Chest CT
  • Contrast enhanced computed Tomography (CT Scan) or magnetic resonance (MRI). Both need to be performed following a specific protocol for contrast administration.
  • Liver Ultrasound
  • Targeted liver mass biopsy (in certain cases)

Treatment

Surgery

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 focus on liver cancer surgery. Our team works in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier. Surgical care includes complex, removal of multiple sections of the liver (multisegment liver resection), and minimally-invasive approaches such as robotic surgery and laparoscopic ablation. 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

Interventional Radiology

The Interventional Radiology Program at Smilow Cancer Hospital provides treatment options for patients with liver cancer who are unable to undergo surgery or liver transplant. This program provides treatment using targeted, minimally invasive approaches including:

  • Ablation Therapy: is used when tumor removal, either by transplant or resection, is not feasible or advisable.
  • IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to targeted cancer areas, while minimizing surrounding tissue damage in the liver.
  • Portal Vein Embolization (PVE): a technique that is performed before a liver resection to increase the size of liver segments that will remain after surgery.
  • 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.
  • Transarterial chemoembolization (TACE): delivers chemotherapy through a catheter directly to the tumor and is the most widely used primary treatment for primary liver cancers

Medical oncology

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). Immunotherapy is 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 Oncology

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.

Supportive Care

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.

Contact Us

Liver Cancer Program
203-200-5487 (LIVR)

Cancer Support Groups

Smilow Cancer Hospital at Yale New Haven offers cancer support groups.

Marissa: Liver Cancer Survivor

Marissa: Liver Cancer Survivor

It was apparent from the start that Marissa Antonio’s case was unique. She was just 39 and a new mother when an MRI revealed a 19cm tumor in her liver, and unlike with most cases, she did not have any complicating disease in the liver, such as cirrhosis. Marissa knew something was not right when she started having pain on her right side and was more tired than normal.