Liver and Bile Duct Cancer
Ghassan K. Abou-Alfa, William Jarnagin, Maeve Lowery, Michael D’Angelica, Karen Brown, Emmy Ludwig, Anne Covey, Nancy Kemeny, Karyn A. Goodman, Jinru Shia and Eileen M. O’Reilly
Summary of Key Points
Liver Cancer
• There is a continued rise of hepatocellular carcinoma (HCC) incidence especially in the Western hemisphere.
• HCC main risk factors are hepatitis B, hepatitis C, alcohol, and nonalcoholic steatohepatitis.
• Screening programs continue to evolve, but depend mainly on ultrasound and α-fetoprotein (AFP) evaluations.
• Staging of HCC depends on evaluating the two aspects of the disease: the cancer itself, and the commonly associated cirrhosis.
• Pathology evaluation may help distinguish variants or combined HCC and cholangiocarcinoma.
• Patterns of spread are hematogenous, and may involve lung and bones.
• Surgery, liver transplantation, and radiofrequency ablation (RFA), are the sole proven curative therapies for HCC.
• Locally advanced disease is generally treated with different forms of local therapies, including but not limited to, transarterial chemoembolization, bland embolization, radioembolization, and radiation therapy.
• Sorafenib is the sole drug approved for the treatment of advanced HCC, based on an improvement in survival compared with placebo.
• Future developments are likely to be dependent on the evaluation of combination therapies and/or the development of new targets.
• Future studies are most likely to entail enriched patient populations based on biology, risk factors, and/or etiology.
Biliary Tumors
• The majority of biliary tumors are adenocarcinomas.
• Despite their similarities, biliary tumors are now better understood as three different diseases: gallbladder cancer, extrahepatic, and intrahepatic biliary tumors, with different clinical and biological characteristics.
• Gallbladder resection may require resection of segments IVA and V of the liver plus a locoregional lymph node dissection for better tumor control and staging.
• Preoperative considerations for extrahepatic biliary tumors include percutaneous transhepatic biliary drainage.
• Surgical therapy for distal extrahepatic cholangiocarcinoma is a pancreaticoduodenectomy, as for all periampullary malignancies.
• No adjuvant therapy has been proven effective for biliary tumors.
• The standard of care for advanced disease consists of gemcitabine plus cisplatin based on the ABC-02 study.
