Liver Cancer: Diagnosis & Treatment at Memorial Sloan-Kettering

Pictured: Ghassan Abou-Alfa & Eileen O'Reilly Oncologists Ghassan Abou-Alfa (left) and Eileen O'Reilly work with a multidisciplinary team to ensure the best possible care for patients with primary liver cancer.

Memorial Sloan-Kettering has a long-standing commitment to improving the detection and treatment of primary liver cancer, which begins in the liver, with a goal of developing more effective therapies for this disease. In the past decade, our team has treated more than 5,000 patients with primary liver cancer.

The most common type of primary liver cancer is hepatocellular carcinoma, which arises in liver cells known as hepatocytes. (Cholangiocarcinoma begins in the bile ducts within the liver. For information about this type of cancer, visit the Gallbladder and Bile Duct Cancer information on our Web site.).

We also treat many types of benign liver tumors, as well as a rare type of liver cancer called fibrolamellar-hepatocellular carcinoma. For more information about the different types of liver tumors that we treat, visit About Liver Cancer.

Team Approach to Care

Memorial Sloan-Kettering takes a multidisciplinary team approach to providing the best possible diagnosis, treatment, and palliative care for patients with liver cancer. Our team includes:

  • surgeons
  • medical oncologists, who treat cancer with chemotherapy and novel biologic therapy
  • radiation oncologists, who use radiation therapy to shrink tumors
  • gastroenterologists, who diagnose and treat disorders of the digestive system
  • diagnostic radiologists, who use imaging to diagnose diseases
  • interventional radiologists, who deliver nonsurgical, minimally invasive therapies
  • pathologists, who identify diseases by studying cells and tissues under a microscope
  • nurses
  • psychiatrists
  • social workers
  • complementary medicine specialists
  • nutritionists

Members of our liver cancer team meet weekly to review patient cases, bringing a variety of clinical perspectives and experience to the development of an individualized treatment plan. The team also participates in a weekly meeting to share clinical trial results, review information from surgical pathology reports, and plan future research studies.

Our doctors are active members of the American Society of Clinical Oncology (ASCO), Cancer and Leukemia Group B (CALGB), the American College of Surgeons Oncology Group (ACOSOG), Society of Interventional Radiology (SIR), and the Radiation Therapy Oncology Group (RTOG), and participate in most national clinical trials to improve the detection, treatment, and prevention of liver cancer.

Our Nursing Staff

At Memorial Sloan-Kettering, we have a dedicated team of nurses who specialize in caring for patients with liver cancer during outpatient visits and inpatient hospital stays. Each nurse works in collaboration with one primary physician to oversee the patient's care. This allows our nurses to assess a patient's needs, triage symptoms, and, if necessary, make referrals to other departments within Memorial Sloan-Kettering, such as integrative medicine, nutrition, and social work. Nurses also help patients understand the details of the treatment plan and what to expect throughout the course of treatment. They are actively involved with teaching both patients and their families, and provide educational materials as needed.

As the liaison between patients and physicians, nurses play an important role in the team approach to care offered at the Center.

Individualized Treatment

Our Publications Visit PubMed for journal articles from our liver cancer experts Go »

If liver cancer is suspected, diagnosis may be confirmed through a biopsy, in which a small sample of liver tissue is removed and examined under a microscope. Once a diagnosis has been established, additional tests may be required to determine the extent (stage) of the tumor and the presence of other liver conditions, such as hepatitis, cirrhosis, and diabetes, all of which can affect the choice and outcome of treatment. (Learn more about the risk factors for developing liver cancer.)

Multidisciplinary input is an important aspect of the treatment plan, since many patients will receive more than one type of treatment. For liver cancer, this may include some combination of surgery and nonsurgical treatments such as ablation, embolization, chemotherapy (systemic or using hepatic arterial infusion [described below]), biologic therapy, and radiation therapy. Having a team of specialists collaborating on treatment from the very beginning optimizes patient care.

Focus on the Patient

Communication with patients and caregivers is an important priority at Memorial Sloan-Kettering. We believe that treating the whole person, not just the disease, is best for patients and family members. Memorial Sloan-Kettering offers a broad range of emotional support programs designed to help patients and family members cope with the range of issues related to life during and after cancer treatment. For more information about the services we offer, please visit Survivorship & Support.

Our Surgical Experience

Memorial Sloan-Kettering's liver surgeons safely perform nearly 300 surgical procedures each year to remove liver tumors. A recent study demonstrated an improvement in outcomes and long-term survival among patients who are treated at hospitals that perform a higher volume of liver surgeries.(1) Our surgeons are continuously working to improve the effectiveness and reduce complications of liver surgery, and we routinely offer surgical treatment to many patients of all ages whose tumors are considered inoperable at other hospitals. Memorial Sloan-Kettering surgeons also are experienced in diagnosing and removing large benign liver tumors, which can bleed or cause abdominal pain but do not pose additional health risks.

Surgeons at Memorial Sloan-Kettering developed a technique that significantly reduces the need for blood transfusions during liver surgery. In addition, our doctors are refining liver-sparing surgical techniques that leave more of the healthy portion of the liver intact.(2) Most liver surgery patients at Memorial Sloan-Kettering require a hospital stay of less than ten days.

Minimally Invasive Techniques

Our surgeons frequently use minimally invasive surgical techniques to determine the extent of the cancer and whether it has spread outside of the liver. Doctors insert a laparoscope — a thin, lighted tube with a camera at its tip — through a tiny incision in the patient's abdomen to view the liver and surrounding areas.

Many liver tumors can be surgically removed (resected) using a laparoscope and other minimally invasive instruments, which can reduce discomfort, facilitate recovery, and reduce the length of stay in the hospital compared with traditional surgery. Our surgeons were among the first to use laparoscopic techniques in the treatment of liver cancer and helped develop national guidelines for laparoscopic liver surgery.(3)

Memorial Sloan-Kettering's interventional radiologists and surgeons offer a variety of safe and effective procedures that use CT scans, ultrasound, and laparoscopy to guide the delivery of treatments directly to the tumor site, without making a large incision. Our team performs more than 400 minimally invasive liver procedures each year and is experienced in identifying patients who will most benefit from therapies such as embolization, which shrinks tumors by blocking their supporting blood vessels, and thermal ablation, which uses heat, cold, soundwaves, or electrical currents to destroy tumor cells. A study is currently underway to assess the value of a procedure that delivers targeted chemotherapy to the tumor with chemotherapy-laced beads.

Multimodal Therapy for Advanced Liver Cancer

Many patients with liver cancer cannot be treated with surgery because of the extent of their cancer or underlying liver disease, such as cirrhosis. Memorial Sloan-Kettering offers a number of treatments aimed at eliminating liver tumors and improving quality of life for these patients. Treatment plans may include one or a combination of treatments, including minimally invasive procedures (described above), chemotherapy and biologic therapy, or radiation therapy.

Chemotherapy & Biologic Therapy

Memorial Sloan-Kettering is pursuing several novel strategies to improve non-surgical treatment of patients with advanced or recurrent liver cancer. Although results vary widely, systemic chemotherapy plays an important role in the treatment of patients with advanced liver cancer. Chemotherapy also may be given to shrink liver tumors before surgery.

Our doctors led the first clinical trial that evaluated sorafenib, a novel biologic that stop liver cancer cells from replicating or target the blood vessels that nourish liver tumors.(4),(5) They have since evaluated several other novel biologic agents singly or in combination. The group is also the leader in the novel development of the combination of biologic and chemotherapy for primary liver cancer.

Our doctors pioneered the clinical development of a highly targeted chemotherapy technique called hepatic arterial infusion (HAI), which delivers chemotherapy drugs directly to the liver through a pump in the abdomen.(6),(7) In a recent study conducted at Memorial Sloan-Kettering, 67 percent of patients with primary liver cancer survived for at least two years when treated with HAI chemotherapy alone.(8)

Our team of physician-scientists is working to develop novel biologic therapies that stop liver cancer cells from replicating or target the blood vessels that nourish liver tumors. In addition, researchers at Memorial Sloan-Kettering are evaluating new methods of assessing a tumor's response to therapy, including nuclear imaging technology and the measurement of different tumor markers in the blood.

  1. Y. Fong, M. Gonen, D. Rubin, M. Radzyner, and M.F. Brennan, Long-term survival is superior after resection for cancer in high-volume centers, Annals of Surgery 242(4) 2005:540-4.
  2. W.R. Jarnigan, M. Gronen, Y. Fong, R.P. DeMatteo, L. Ben-Porat, S. Little, C. Corvera, S. Weber, L.H. Blumgart, Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade, Annals of Surgery 236(4) 2002:397-406.
  3. K. Ito, C. Are, P.J. Allen, Y. Fong, R.P. DeMatteo, W.R. Jarnagin, M.I. D'Angelica, Laparoscopic versus open liver resection: a matched-pair case control study, Journal of Gastrointestinal Surgery 2009.
  4. Abou-Alfa GK, Zhao B, Capanu M, Guo P, Liu F, Jacobs G, Gansukh B, Moscovici M, Lentini G, Schwartz L. Tumor Necrosis as a Correlate for Response in Subgroup of Patients with Advanced Hepatocellular Carcinoma (HCC) Treated with Sorafenib. ESMO 2008, Stockholm, Sweden.
  5. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J; SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24;359(4):378-90.
  6. N.E. Kemeny, D. Niedzwiecki, D.R. Hollis, H.J. Lenz, R.S. Warren, M.J. Naughton, J.C. Weeks, E.R. Sigurdson, J.E. Herndon 2nd, C. Zhang, and R.J. Mayer, Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481), Journal of Clinical Oncology, 24(9) 2006:1395-403.
  7. N. Kemeny, Y. Huang, A.M. Cohen, W. Shi, J.A. Conti, M.E. Brennan, J.R. Bertino, A.D. Turnbull, D. Sullivan, J. Stockman, L.H. Blumgart, and Y. Fong, Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer, New England Journal of Medicine, 341(27)1999:2039-48.
  8. W.R. Jarnigan, L.H. Schwartz, D.H. Gultekin, M. Gonen, D. Haviland, J. Shia, M. D'Angelica, Y. Fong, A. Tse, L.H. Blumgart, and N. Kemeny, Regional chemotherapy for unresectable primary liver cancer: results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival, Annals of Oncology 20(9) 2009:1589-95.
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