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Liver cancer is one of the most rapidly increasing types of cancer in the United States. Liver cancer is a cancer that begins in the cells of your liver. Cancer that spreads to the liver is more common than cancer that begins in the liver cells.
At Ochsner Health, our patients benefit from our collaborative approach to treating liver cancer by a highly skilled team of physicians, oncology nurses, social workers, researchers and other healthcare professionals. We provide hope to our patients by treating advanced cancer stages and complex cases. Our environment fosters innovation and collaboration to produce excellent outcomes for liver cancer treatment. Our current three-year risk adjusted mortality index is 0.49 for liver resection. This means our mortality rate is much less than expected for our patient population.
The Ochsner Cancer Institute Liver Tumor Treatment Center offers the full spectrum of cutting-edge technologies for care of patients with liver cancer and other liver tumors close to home. Our patient-centered approach ensures the highest quality care while maintaining patient comfort, minimizing treatment-related stress and anxiety.
Ochsner Health has been nationally recognized as High Performing Hospital for Cancer Care by U.S. News & World Report in 2020-2021.
A team of physicians, surgeons and other healthcare professionals dedicated to liver cancer diagnosis and treatment work together to deliver the most effective treatment and support available. We provide our patients with specialized knowledge that can make all the difference in treatment, quality of life and recovery.
Our team consists of surgical oncologists, transplant surgeons,
medical oncologists, radiation oncologists, gastroenterologists and
radiologists. The team discusses strategies for possible treatment
including surgery, chemotherapy, radiation, liver transplantation
and clinical trial opportunities. Our dedicated nurse navigators work
with patients and referring providers to facilitate scheduling
appointments, coordinating home care, follow-up phone calls and help
obtain records. They also help with extensive patient and family
education which is vital to successful treatment.
To schedule an appointment, please call 504-842-4070.
You may call the Ochsner Cancer Institute oncology team directly at 504-842-3910 for urgent symptoms and health issues, 24 hours a day.
We offer same-day and next-day appointments. The physician support staff will coordinate with referring physicians to obtain a timely consultation and ensure all necessary studies are scheduled. We also offer virtual visits. If you are a new patient, your first virtual appointment is at the discretion of the provider. Learn more about virtual visits, here.
You may also schedule online through the MyOchsner patient portal. This allows you to conveniently schedule your next appointment yourself.
Ochsner Health has taken strides for treating this condition and patients now have a better chance for long-term survival. Using advanced technologies, we offer treatments to patients with extensive, bilateral liver involvement, a better chance at life.
It’s common for patients with liver cancer to not have any signs of symptoms in the early stages. When signs and symptoms do appear, they may include:
Schedule an appointment with one of our physicians if you experience any symptoms that worry you.
From clinical research trials to the most advanced technologies in diagnosis and treatment, Ochsner Health creates a treatment plan that is personalized for each patient. Your case will be reviewed by our multidisciplinary team to decide which treatment option is best for you. This decision is based on a number of factors including liver function, location of the tumor(s), size of the tumor, if the tumor has spread to other sites (metastasis) and functional capacity. Our treatment options include:
Participating in a clinical trial may be a treatment of choice for some patients. These trials are done to find out if new cancer treatments are safe and effective. The standard treatments we use today were effective on earlier clinical trials. Our patients who enroll in a clinical trial may be the first to receive a prospective new treatment. These patients also help improve the way cancer will be treated in the future. If the trial does not lead to effective new treatments, they pave the way for our researchers by answering important questions moving forward.
Our team will be by your side during every step of your journey. Routine imaging will be done to monitor the status of your liver cancer.
Liver transplantation, in the context of multi-modal treatments, can offer hope for many patients with advanced liver cancer.
In most cases, the best chance for long-term survival is achieved with liver resection to remove the tumor(s), sometimes in combination with chemotherapy or radiation before/after surgery. Unfortunately, many liver cancers are diagnosed at an advanced stage or in the setting of other liver diseases, and surgical resection is not possible. With liver transplantation, the entire liver is removed, including the cancer, and replaced with a new liver and can be performed in many cases when resection is not possible. The success of liver transplantation for cancer depends on controlling the tumor with chemotherapy or radiation before transplant to ensure that it is confined to the liver.
Our multi-disciplinary team will formulate a personalized plan using multiple treatment modalities to provide the best chance for cure.
Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and has the most clearly defined role for liver transplantation.
HCC occurs most frequently in patients with chronic liver disease, such as hepatitis C or fatty liver disease. Chronic inflammation and infection from these diseases damages the liver cells making them more likely to transform into a cancer. In many cases, these chronic diseases cause cirrhosis, or scarring of the liver, making liver resection unsafe. Liver transplant plays a central role in managing HCC tumors because they so commonly occur in the background of liver disease. Even if the primary tumor can be removed surgically, if the remaining liver is diseased, the risk of new tumor formation is high. With liver transplantation, the entire diseased liver is removed, reducing the risk of tumor recurrence.
There may be benefits to liver transplantation even when resection is possible. All cases of HCC should be evaluated at a transplant center to determine potential benefit from transplant.
The benefit of liver transplantation in treatment of HCC has been extensively studied and is clearly defined. A landmark study in the early 1990’s from Milan, Italy defined the criteria by which patients most benefit from liver transplantation for HCC, aptly named the Milan criteria. These criteria defined limits to the size (5cm) and number (<4) of tumors in the liver to achieve average 5-year survival after liver transplantation >%70. Since that time, these criteria have evolved to include a pathway for tumors beyond these criteria. Through a process called downstaging, targeted delivery of radiation beads (Y90), chemotherapy beads (TACE) or ablation of the tumors is used to shrink the tumors to the size and number of the Milan criteria and consider the option of liver transplant. More recently, new systemic immunotherapy treatments can be used to control and shrink very advanced tumors for downstaging and consideration for liver transplant.
Cholangiocarcinoma is a cancer of the bile ducts within the liver.
There are two types of this cancer that occur in the liver:
Hilar cholangiocarcinoma (hCCA) occurs in the center of the liver where the main bile ducts come together. As the tumor blocks the drainage of bile from the liver, it often causes symptoms of jaundice, dark urine and itching.
Intra-hepatic cholangiocarcinoma (iCCA), by contrast, arises from bile ducts from within the liver to form a tumor. Because it can occur anywhere in the liver, it rarely causes symptoms of bile duct obstruction. In most cases, these tumors are asymptomatic and are discovered incidentally on abdominal imaging (ultrasound or CT scan) or with abnormalities in routine liver tests.
Although both types of CCA arise from bile duct cells, the treatment and behavior of these tumors is different. Liver transplantation is an important treatment option for both types.
Liver transplantation has a well-established and increasingly important role in the treatment of hilar cholangiocarcinoma (hCCA). Several decades ago, the outcomes of liver transplantation for hCCA were poor with early recurrence of the tumor after transplant and poor patient survival. In the early 2000s, a team at Mayo clinic developed an approach to transplant that included treatment of the cancer before transplant, (referred to as neoadjuvant therapy). By treating the tumors with radiation and chemotherapy upfront, the objective is to ensure the tumor is confined to the liver and controlled so that, at the time of transplant, the cancer is removed entirely with the old liver. Using this approach, the outcomes were markedly improved, with 3-year patient survival of 70-80% compared with 10% or less with conventional chemotherapy alone.
Ochsner is the only transplant center in the Gulf South region with an established liver transplant protocol for hCCA. Our approach is similar to the protocol originally developed at the Mayo Clinic. The process begins with imaging (CT,MRI, PET scans) and endoscopy (scope through the esophagus) to determine the extent of the cancer. ERCP, a procedure performed with a scope similar to a colonoscopy, is performed to diagnosis the cancer and treat bile duct obstruction. During this procedure, our advanced endoscopists take pictures of the bile ducts, use brushes to sample the cells to look for cancer, and typically leave a stent in place to keep the bile ducts open. They will also use ultrasound to look for any enlarged lymph nodes around the liver and sample some tissue to ensure the cancer has not spread outside the liver. If there is no evidence of spread outside the liver, treatment can begin with a combination of radiation therapy and chemotherapy as well as evaluation for transplant. After radiation treatment is completed, chemotherapy is continued, and the patient is made active on the liver transplant waitlist. At the time of transplant, the cancer is removed with the native liver and closely examined by a pathologist to understand the extent of the tumor and response to the radiation and chemotherapy treatments. After recovery from transplant, additional chemotherapy is often recommended to reduce the risk of recurrence.
Intra-hepatic cholangiocarcinoma (iCCA) is often discovered incidentally on imaging or evaluation of abnormal liver tests. When iCCA is discovered at an early stage, liver resection (removal of part of the liver with surgery) is often the best treatment option. Unfortunately, because it rarely causes symptoms, these tumors are often diagnosed at more advanced stages where the tumor is too large to be removed surgically. In these cases, a combination of systemic chemotherapy and targeted-delivery of radiation therapy are used to control the tumor. Using advanced techniques for genetic sequencing of tumors, there may specific mutations in the tumor that can be targeted with specialized chemotherapy and immunotherapy agents. Using catheters within blood-vessels, radiation beads can be delivered directly to the tumor in the liver to concentrate the effects of killing the tumor cells but limiting side-effects or damage to surrounding tissues. With this combination of treatments, some tumors will shrink is size and remain stable within the liver. With a good response to these treatments, liver transplant can be considered to remove the entire liver and tumor. Because this is a rare cancer, each case is carefully considered with a multi-disciplinary treatment team to develop a personalized treatment approach for each patient.
Hepatoblastoma is a rare tumor that originates in the cells of the liver and it’s the most common liver cancer in children, particularly below 5 years of age. The tumor presents a large mass in the abdomen (swollen belly), weight loss, poor appetite, vomiting, skin and eyes yellowing (jaundice), itching.
The goal of treatment is to remove the tumor and frequently chemotherapy, radiation and other therapies are required to shrink it before surgery. Unfortunately, many times, the size and/or location of the tumor don’t allow a complete and safe resection and the whole liver must be removed and replaced through a liver transplant.
Prognosis and long-term survival vary from child to child. Integrate medical attention is important for the best prognosis.
Neuroendocrine tumors (NET)that spread (metastasis) and localized in the liver are mostly treated through surgical remotion. Sometimes, however, the extension and severity of the disease make them unresectable. Liver transplantation should be considered in patients with NET to the liver that are not candidates for surgery, if local treatment has failed or if there are life threatening hormonal symptoms.
Liver transplantation for those tumors could be used successfully as they have a low biological aggressiveness and are slow growing. However, due to high recurrence rates, strict selection of patients is critical.
Almost half of patients who have cancer in the colon or rectum will see their cancer spread to the liver at some point during their disease. The spread, known as metastasis, has significant impact on survival, quality of life and treatment options. Without treatment, the outcomes are poor: 10-20% survival at 5-years. Resection of the affected area of the liver is the best option for those patients with liver only metastases since it improves the overall 5-year survival to 40-60%. Unfortunately for most of the patients, the disease usually presents too advanced for resection.
More than 3 decades ago, liver transplantation was used to treat colorectal liver metastasis, sadly with very poor outcomes. However, over the last few years, there have been significant advances in the fields of colorectal cancer and liver transplantation. Thus, a unique approach developed at University of Oslo combining different therapeutic options that include liver transplantation has obtained a promising survival of 83% at 5 years in patients with unresectable liver metastases of colorectal cancer.
The goal of this protocol is to provide an alternative of care to patients with liver metastases from colorectal cancer that have failed other therapeutics options and/or are not candidates for extensive liver surgeries by removing a diseased liver and replacing it with a healthy one.
Although each case will be carefully evaluated by our multi-disciplinary team to develop a personalized treatment approach, to be eligible for a liver transplantation, patients must have:
Even though those impressive outcomes have been reached in a very select group of patients, this approach provides the longest overall survival reported at this advance stage of disease where other therapies are not feasible.
Liver transplantation for colorectal metastases is part of our Colorectal Cancer Liver Metastases program. This is a personalized program that integrate a multidisciplinary team that includes oncology, surgery, radiology, hepatology, and transplantation that work together to implement a novel protocol that is offered in only a few centers in the world.
Ochsner has one of the largest liver transplant programs in the country with excellent outcomes in the top percentile in the nation. Because of the higher rates of chronic liver disease in our region, we have extensive experience treating liver cancer and have incorporated the most advanced treatments to maximize options for patients. Our dedicated multi-disciplinary team works closely together to develop a treatment plan that is clear, coordinated, and efficient. We welcome patients with a new diagnosis, those looking for a second opinion or seeking alternative treatment options.
Our dedicated multi-disciplinary team works closely together to develop a treatment plan that is clear, coordinated, and efficient. We welcome patients with a new diagnosis, those looking for a second opinion or seeking alternative treatment options.
Our services include:
The Ochsner Transplant Institute provides consistent follow-up information to all referring physicians via written correspondence. You’ll be kept abreast of initial clinic visits, surgery, hospital discharge and routine follow-up visits to the clinic. After surgery, our team continues to monitor for transplant-related complications and regulates maintenance immunosuppression.
To schedule an appointment, please call us at (504) 842-3925.
To refer a patient to one of the best liver transplant hospitals in the country, call our 24-hour Referral Hotline: 1-800-643-1635 or email referrals to: LiverTransplant@Ochsner.org.
The Ochsner Transplant Institute provides consistent follow-up information to all referring physicians via written correspondence. You’ll be kept abreast of initial clinic visits, surgery, hospital discharge and routine follow-up visits to the clinic. After surgery, our team continues to monitor for transplant-related complications and regulates maintenance immunosuppression.
To refer a patient to one of the best liver transplant hospitals in the country, call our 24-hour Referral Hotline: 1-800-643-1635 or email referrals to: LiverTransplant@Ochsner.org.
Routine cancer screenings can help diagnose conditions early, when they are easier to treat. Regular visits with your physician are an important way to stay healthy throughout your life.
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