In a highly supportive and collaborative environment, physicians who are nationally recognized leaders in the care of patients with all stages of liver cancer provide patients with the most advanced, coordinated, and comprehensive medical care available—treatment that is effective and innovative in curing and controlling cancer and managing its impact on quality of life.

At BMC, diagnosis and treatment of patients with liver cancer combine the resources of a multidisciplinary clinical center dedicated to personal, patient-focused care with the state-of-the-art expertise and technological advances of a major teaching hospital. As the primary teaching affiliate of the Boston University School of Medicine, BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.

Boston Medical Center’s Hepatobiliary and Pancreatic Tumor Program was established in 2008 to effectively treat the growing number of patients being diagnosed with cancers of the liver, biliary tree, gallbladder, and pancreas.

"My sister has cancer and Dr. Sachs performed her surgery. We are so happy with him. He takes the time to speak with you and answer all questions. He returns phone calls promptly. He is a caring and wonderful Doctor. Would recommend him without hesitation. Although I have not been his patient, I write this for my sister. All we can say is what he is a wonderful, caring Doctor that will take all the time you need."

~ Anonymous

What Is Liver Cancer?

Liver cancer is a type of cancer that is caused by the abnormal growth of cells in the liver.

The liver is the largest organ in the abdomen. It is located on the right side of the body, behind the right ribs and below the right lung. It is divided into left and right lobes.

The liver gets its blood supply from two sources: the hepatic artery, which supplies the liver with oxygen-rich blood, and the portal vein, which supplies the liver with nutrient-rich blood from the intestines. The portal vein is the liver’s primary source of blood.

The liver performs several functions. It breaks down toxic substances in the blood and gets rid of them. It produces enzymes and bile that help digest food and turn it into substances the body needs to sustain itself and grow. It also produces proteins and clotting factors important in healing.

Growths in the liver can be benign (noncancerous) or malignant (cancerous). Benign growths are generally not life threatening, can often be removed, and do not spread to distant sites in the body. Malignant growths can spread to distant sites in the body and may be life threatening.

The two types of liver cancers are primary liver cancers and secondary liver cancers.

Primary Liver Cancers

Primary liver cancers are cancers that begin in the liver. There are several types of primary liver cancers, but the two most common are:

  • Hepatocellular carcinoma (HCC): Hepatocellular carcinoma, also called malignant hepatoma, develops in the hepatocytes (the main type of liver cell). It is the most common form of liver cancer in adults. Approximately 4 out of 5 primary liver cancers are HCCs (American Cancer Society 2015).
  • Intrahepatic cholangiocarcinoma (bile duct cancer): Intrahepatic cholangiocarcinoma develops from cholangiocytes (bile duct cells) located inside the liver. These cholangiocytes line the bile ducts, which facilitate excretion of bile produced by the liver. Intrahepatic cholangiocarcinoma accounts for 1 or 2 out of every 10 cases of liver cancer (American Cancer Society 2015).

Secondary Liver Cancers

Secondary liver cancers are cancers that develop in other parts of the body and metastasize (spread) to the liver. The most common of these is cancer of the gastrointestinal tract, like colon cancer. These cancers often require multiple specialists in order to achieve the best survival. Even though these are metastatic cancers, many times the potential of cure is still possible.

Primary liver cancers are the focus of the rest of these pages.

Symptoms of Liver Cancer

Many early-stage liver cancers do not cause symptoms, with symptoms only developing with progression. Common symptoms include:

  • Abdominal pain
  • A bulge on the right side
  • Unintentional weight loss
  • Lack of appetite
  • Feeling full without eating a lot
  • Nausea and vomiting
  • Bloating
  • Fever
  • Yellowing of the eyes (icterus)
  • Yellowing of the skin (jaundice), pale stools, and dark urine
  • Fatigue

Many of these symptoms can be caused by health problems other than liver cancer. Patients experiencing any of these symptoms should see their physician.

Causes of Liver Cancer

Although the exact causes of liver cancer remain unknown, certain risk factors connected to the disease have been identified. A risk factor is anything that affects one’s chance of getting a disease. While risk factors may be useful in identifying high-risk individuals, they do not determine whether a person develops a disease. Some risk factors, such as alcohol consumption, are within the individual’s control, while others, such as gender, are not.

Possible risk factors for liver cancer include:

  • Gender: Men develop liver cancer more often than women.
  • Ethnicity: Asian Americans and Pacific Islanders have the highest risk of developing liver cancer.
  • Location: The disease is less prevalent in the United States than in other places in the world, such as countries in sub-Saharan Africa and Southeast Asia.
  • Hepatitis B virus (HBV) or Hepatitis C virus (HCV): Long-term infection with either of these viruses may increase a person’s risk of developing liver cancer.
  • Hemochromatosis: Hemochromatosis is a disease that causes the body to take up and store too much iron. The body stores the excess iron in the heart, liver, and pancreas. The disease may be hereditary (passed on from one’s parents), or it may result from blood transfusions. Having hemochromatosis may increase a person’s risk of developing liver cancer.
  • Cirrhosis: Cirrhosis is a disease that develops when liver cells become damaged and are replaced by scar tissue. Infection with HBV and HCV, heavy alcohol consumption, hemochromatosis, and certain drugs and parasites can all cause liver damage. People with cirrhosis are prone to developing liver cancer.
  • Environmental factors and toxins: Several environmental factors, such as aflatoxin (a toxic substance produced by certain types of mold that grows on some foods), and toxins, such as tobacco, alcohol, and solvent vinyl chloride (a substance used in the production of plastics), can increase a person’s risk of developing liver cancer.
  • Anabolic steroids: Using anabolic steroids (substances that act like the male hormone testosterone) may put a person at greater risk of developing liver cancer.
  • Obesity and diabetes: Being obese (very overweight) or having type 2 diabetes may increase a person’s risk of developing the disease.

Liver Cancer Staging

Staging is used to determine the extent of the cancer and treatment options. There are several different staging systems in place for liver cancer. Some staging systems, such as the American Joint Committee on Cancer’s TNM system, look only at how widespread the cancer is. Other systems also take liver function into account.

Physicians frequently categorize liver cancers by whether they can be resected (surgically removed) or not. Surgery is a potential treatment for many patients diagnosed with a tumor or tumors within the liver. These include primary tumors, which originate in the liver, and secondary tumors that develop in other parts of the body and spread to the liver. Staging helps physicians determine the best treatment options for patients.

A liver cancer can potentially be placed into one of five categories:

  • A liver cancer is potentially resectable if surgery can be used to remove the cancer, and the health of the patient permits it.
  • It is potentially transplantable if the surgeon is able to perform a liver transplant.
  • It is unresectable if the surgeon cannot remove the cancer, but it has not spread beyond the liver.
  • The cancer is inoperable with only local disease if surgery could be used to remove the cancer, but the health of the patient does not permit it.
  • It is metastatic if the cancer has metastasized (spread) beyond the liver. (American Cancer Society 2015)

Liver function is key to determining the best treatment options for patients. A system called the Child-Pugh score helps physicians determine how well the liver is functioning based on the measures of different substances in the blood, fluid in the belly, and brain function.

Patients are encouraged to discuss cancer staging and treatment options with their physicians.

References

American Cancer Society. 2015. Liver Cancer Overview. PDF. http://www.cancer.org/acs/groups/cid/documents/webcontent/003058-pdf.pdf

National Cancer Institute. 2009. What You Need To Know About™ Liver Cancer. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. https://ccr.cancer.gov/liver-cancer-program

Contáctenos

Tratamientos y Servicios

Ablación de tumores

La ablación de tumores es un tratamiento mínimamente invasivo guiado por imágenes que se utiliza para destruir las células cancerosas. En la ablación de tumores, un médico inserta una aguja (sonda) especialmente equipada en el tumor o tumores guiado por tomografía computarizada (TC). Una vez que la sonda está en su lugar, la energía se transmite a través de ella hacia el tumor.

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Ablación de tumores: microondas

En el que las ondas de radio calientan la sonda para matar las células cancerosas.

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Inyección percutánea de etanol

La inyección percutánea de etanol utiliza etanol, un tipo de alcohol, para destruir las células cancerosas. El médico guía el etanol directamente hacia el tumor mediante ultrasonido. Generalmente, este procedimiento solo requiere anestesia local. Si el paciente tiene múltiples tumores, puede requerir anestesia general.

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Quimioembolización transarterial (TACE)

TACE inyecta perlas recubiertas de quimioterapia directamente en un tumor al mismo tiempo que bloquea su suministro de sangre. Esto permite que una dosis alta de medicamentos de quimioterapia se concentre en el sitio del tumor durante un período de tiempo más prolongado y tenga poco efecto en el resto del cuerpo.

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Radioembolización

La radioembolización inserta perlas radiactivas en la arteria para administrar una pequeña dosis de radiación directamente a los tumores.

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Terapia dirigida

La terapia dirigida es un tipo de tratamiento contra el cáncer que usa medicamentos u otras sustancias para identificar y atacar con precisión las células cancerosas. Por lo general, la terapia dirigida daña menos las células normales que otros tratamientos contra el cáncer.

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Quimioterapia

La quimioterapia es un medicamento o una combinación de medicamentos que se usan para tratar el cáncer. La quimioterapia puede administrarse por vía oral (en forma de pastilla) o inyectarse por vía intravenosa (IV).

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Radioterapia

La radiación utiliza un equipo especial para liberar partículas de alta energía, como rayos X, rayos gamma, haces de electrones o protones, para matar o dañar las células cancerosas. La radiación (también llamada radioterapia, irradiación o terapia de rayos X) se puede administrar internamente a través de la implantación de semillas o externamente usando aceleradores lineales (llamada radioterapia de haz externo o EBRT).

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CyberKnife

CyberKnife emite haces de radiación altamente dirigidos directamente a los tumores, de forma indolora y no quirúrgica. Guiados por un software de imágenes especializado, podemos rastrear y ajustar continuamente el tratamiento en cualquier punto del cuerpo, y sin la necesidad de los marcos de la cabeza y otros equipos que se necesitan para algunas otras formas de radiocirugía.

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Radioterapia de haz externo

La radioterapia de haz externo es uno de los tipos más comunes de radiación para el tratamiento del cáncer. La radiación proviene de una máquina fuera del cuerpo y la administra a un lugar específico dentro del cuerpo.

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Radioterapia corporal estereotáctica

La radioterapia corporal estereotáxica dirige múltiples haces de energía al tumor desde diferentes ángulos. El oncólogo radioterapeuta puede administrar dosis más altas de radiación al tumor y minimizar el daño al tejido sano circundante.

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Diagnósticos y Pruebas

Liver cancer can be difficult to diagnose early, as symptoms frequently do not develop until the later stages of the disease. Patients experiencing any of the symptoms of liver cancer, or those who have cirrhosis and notice it getting unexpectedly worse, should see their physician.

Gastroenterology/Hepatobiliary Tumor Board

The results of the diagnostic tests are discussed at the Gastroenterology/Hepatobiliary Tumor Board. During this weekly meeting, the entire multidisciplinary team comes together to discuss new cases and develop individualized treatment plans for each patient.

Examen físico para detectar cáncer de hígado

El médico palpa el abdomen en busca de bultos o cambios inusuales en el tamaño y la forma del hígado, el bazo y los órganos circundantes. El médico también revisa el abdomen en busca de una acumulación anormal de líquido llamada ascitis. También puede examinar la piel y los ojos en busca de ictericia (una afección que puede hacer que adquieran un aspecto amarillento).

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Ultrasonido

La ecografía de diagnóstico, también llamada ecografía o ecografía médica de diagnóstico, es un método de obtención de imágenes que utiliza ondas sonoras de alta frecuencia para producir imágenes de estructuras dentro del cuerpo. Las imágenes pueden proporcionar información valiosa para diagnosticar y tratar una variedad de enfermedades y afecciones. La mayoría de los exámenes de ultrasonido se realizan con un dispositivo de sonar fuera del cuerpo, aunque algunos exámenes de ultrasonido implican colocar un dispositivo dentro del cuerpo.

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Tomografía computarizada (TC)

Las tomografías computarizadas utilizan equipos de rayos X y procesamiento por computadora para producir imágenes bidimensionales del cuerpo. El paciente se acuesta en una mesa y pasa a través de una máquina que parece una rosquilla grande y cuadrada.

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Imágenes por resonancia magnética (IRM)

Esta prueba utiliza un campo magnético, pulsos de radiofrecuencia y una computadora para producir imágenes detalladas de las estructuras corporales en varios lugares. Es posible que le pidan que beba una solución de contraste para obtener mejores imágenes, y lo más probable es que se acueste en una mesa en movimiento mientras se toman las imágenes.

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Endoscopia

Recibirá un sedante y analgésico por vía intravenosa. Una vez que se sienta cómodo, el médico examinará el área con un endoscopio, un tubo iluminado con una pequeña cámara en el extremo. El médico podrá ver cualquier anomalía y tomar muestras de tejido (biopsias) si es necesario.

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Angiografía

Una angiografía es una prueba de imágenes que usa rayos X para ver los vasos sanguíneos del cuerpo.

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Gammagrafías óseas

Las gammagrafías óseas implican una dosis baja de material radiactivo que se inyecta en una vena. El hueso atrae este material. Las áreas concentradas aparecen en el escaneo y se denominan "puntos calientes". Los puntos calientes pueden ser indicativos de una variedad de enfermedades y afecciones.

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Análisis de sangre

Una herramienta común para la detección de enfermedades, los análisis de sangre brindan información sobre muchas sustancias en el cuerpo, como glóbulos, hormonas, minerales y proteínas.

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Nuestro Equipo

Medical Oncologists

BMC’s comprehensive hepatobiliary cancer team includes surgeons, medical oncologists, radiation oncologists, gastroenterologists, hepatologists, and interventional radiologists. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.

Matthew H Kulke, MD

Section Chief, Hematology and Medical Oncology
Medical Director, Clinical Cancer Center
Co-Director, BU-BMC Cancer Center
Zoltan Kohn Professor of Medicine, Boston University School of Medicine

Medical Oncology Nurse Practitioners

Radiation Oncologists

Surgical Oncologists

Jennifer F Tseng, MD, MPH

Surgeon-in-Chief, Boston Medical Center
Utley Professor and Chair of Surgery, Boston University School of Medicine

David McAneny, MD

Chief Medical Officer and Senior Vice President of Medical Affairs
Professor of Surgery and Associate Dean for Clinical Affairs, Boston University School of Medicine

Teviah E Sachs, MD, MPH

Section Chief, Surgical Oncology
Associate Professor of Surgery, Boston University School of Medicine, Boston MA

Special Interests

Surgical Oncology, Liver, Pancreas and Biliary Cancers, Cancers of the Stomach, Sarcoma, Melanoma

Provider headshot - surgery department

Surgical Oncology Physician Assistants

Interventional Radiologists

Suvranu Ganguli, MD

Section Chief, Interventional Radiology
Professor of Radiology, Boston University School of Medicine

Kevin P Daly, MD

Program Director, ESIR
Clinical Associate Professor of Radiology, Boston University School of Medicine

Placeholder only - will replace

David Guez, MD

Assistant Professor of Radiology, Boston University school of Medicine

Mikhail Higgins

Director, Medical Student Clerkship
Assistant Professor of Radiology, Boston University School of Medicine

Interventional Radiology Physician Assistants

Gastroenterologists

David P Nunes, MD

Director of Hepatology
Associate Professor of Medicine, Boston University School of Medicine, Boston MA

Christopher S Huang, MD

Director of Endoscopy
Associate Professor of Medicine, Boston University School of Medicine

David R Lichtenstein, MD

Director of Endoscopy Program
Associate Professor of Medicine, Boston University School of Medicine, Boston MA

Gastroenterology Nurse Practitioners

Resumen de la Investigación

Liver Cancer Clinical Trials

BMC offers a number of clinical trials specifically for pancreatic cancer patients. Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing. View an up-to-date list of ongoing trials here. Those interested in participating in any clinical trials at BMC should speak with their physician.

Afiliaciones

Boston University School of Medicine Logo

As the principal teaching affiliate of Boston University School of Medicine (BUSM), Boston Medical Center is devoted to training future generations of healthcare professionals.  Learn more about Boston University School of Medicine.