Q & A: What you need to know about liver cancer

What is liver cancer?

This is a type of cancer that starts in the liver. Primary liver cancer typically affects individuals who already have advanced liver disease or cirrhosis (usually as a result of hepatitis B or C), alcoholic liver disease or fatty liver disease. Because patients are battling two competing diseases — advanced liver disease and liver cancer — care and treatment is complex and requires an experienced, multidisciplinary team.

How does UChicago Medicine approach treatment?

The UChicago Medicine Liver Tumor Program brings together specialists from our cancer and digestive disease programs — two programs ranked among the best in the nation by U.S. News & World Report. Transplant hepatologists, transplant and hepatobiliary surgeons, medical and radiation oncologists, interventional and body radiologists, pain specialists and others offer personalized care for patients with primary liver cancer, bile duct cancer and other benign and malignant tumors of the liver. Transplant hepatologists on our team are experts in determining which liver cancer patients may benefit from liver transplant. This includes patients with other types of cancer that has spread to the liver, including colorectal and bile duct cancer (cholangiocarcinoma).

Why is there a need for a specialized liver tumor program?

A unique thing about liver cancer is that there are often two competing illnesses: end-stage liver disease and the cancer itself. You're not dealing with just one thing, or cancer in an otherwise healthy organ. Our liver tumor program offers a comprehensive, individualized treatment approach to these patients by utilizing the expertise of multiple specialists who treat both liver disease and liver cancer.

Depending on the stage of the cancer and overall liver function, patients have a multitude of options. Ideally, the ultimate goal for many of these patients would be liver transplantation, as it would cure the cancer and remove the diseased liver. So instead of seeing one physician in a silo, you're able to see several specialists in one visit, which is very unique. It makes sense for something this complex.

Why has liver cancer been increasing in the past several decades?

It largely stems from people with advanced liver disease or cirrhosis. The No. 1 cause for that has been infection with the hepatitis C virus. Although the peak of the HCV epidemic occurred in the early 2000s, the downstream detrimental effects — including liver decompensation and liver cancer — will continue and peak around 2030. People with hepatitis C have somewhere between a 2% and 8% risk of developing liver cancer. The other very pertinent issue is the rise of nonalcoholic fatty liver disease, or NAFLD. As people have become more sedentary and obese, putting them at higher risk for metabolic syndrome, there is an increase in NAFLD-associated cirrhosis, and thus liver cancer.

How is liver cancer treated?

We've come a long way in how we treat liver cancer, and the treatment strategy will depend on the specific diagnosis. For patients with localized disease, options include surgery, treatments offered by interventional radiologists or even a liver transplant. We can directly treat the lesion(s) in the liver with several different treatment options, including inserting a catheter to deliver radiation or chemotherapy beads to localized liver tumors. Another treatment involves heating small liver tumors via radio frequency/microwave ablation.

Infographic of the liver's anatomy. Read more about liver transplant.

There is also a wide range of newer treatments for patients with more advanced liver cancer, especially if it has spread outside the liver. These include targeted therapies and also immunotherapies. FDA approved in May 2020, atezolizumab and bevacizumab is the first of these combination therapies to treat advanced liver cancer.

What types of research are underway?

Multiple phase 3 clinical trials are showing promise for treating patients with advanced liver cancer using a combination of chemotherapies. That includes some of the seven new chemotherapy agents approved in the past three years.

Anjana Pillai, MD

Anjana Pillai, MD

Anjana Pillai, MD, is a board-certified gastroenterologist and transplant hepatologist who specializes in the management of chronic liver diseases. Dr. Pillai is the medical director of the multidisciplinary liver tumor program, which encompasses multiple specialists with expertise in benign and malignant tumors of the liver.

See Dr. Pillai's profile
Chelsea Dorsey, MD, wearing surgical scrubs staring into the camera against a black background.

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