Cleveland Clinic’s Liver Cancer Program includes hepatologists, radiologists, oncologists, liver and transplant surgeons, and specialized nurse coordinators – working together as a team. One call puts you in touch with our multidisciplinary team that works with patients who have benign liver tumors, cancerous liver tumors, cirrhosis of the liver and more in order to develop the appropriate treatment plan, aimed at preserving liver function and quality of life.
This new, “one-stop” clinic improves your treatment by eliminating multiple appointments with different physicians at various locations. Now, all of the doctors you need are assembled here under one roof for you. Not only is this model of care more convenient, but it also allows our physicians to create an individualized treatment plan that’s best for you in less than 30 days.
Mission of the Liver Cancer Program
The mission of the Liver Cancer Program is to offer state of the art medical care to patients with hepatic tumors through a multidisciplinary team of experienced health care professional leaders in the field of hepatic oncology.
To make an appointment, call 216.445.8389 or 800.223.2273 ext. 58389.
What We Treat
Primary malignant tumors
- Hepatocellular carcinoma.
- Gallbladder cancer.
Secondary malignant tumors
- Colorectal metastatic liver disease.
- Neuroendocrine tumors.
- All other metastatic hepatic diseases.
At Cleveland Clinic, advanced and diverse surgical techniques and medical oncological therapies are applied to treat complex tumors affecting the liver including:
Up to 70% of the liver volume can be removed if needed. Occasionally, future liver remnant (FLR) volume calculated via computed tomography (CT) or magnetic resonance imaging (MRI) is insufficient. Portal vein embolization is then indicated to achieve growth of the FLR volume. Typically, liver growth after portal vein embolization takes about 4 to 6 weeks. Before proceeding with extended hepatectomy a repeat CT or MRI is obtained for reassessment of liver volume.
ALPPS procedure (Associating liver partition and portal vein ligation for staged hepatectomy)
ALPPS procedure is a two stage hepatectomy in which during the first stage the portal vein branch to the liver lobe less affected by tumor is ligated and the liver parenchyma is divided so volume growth of the FLR is enhanced and achieved faster compared to traditional two stage hepatectomy.
When multiple tumors affect both lobes of the liver a two stage hepatectomy is often needed. During the first stage hepatectomy the lobe of the liver less affected by tumor is treated. Portal vein embolization follows this first operation to achieve enough volume of the cleared liver lobe. The second stage hepatectomy is performed after an interval of 4 to 6 weeks to remove the liver lobe most affected by tumor burden.
When tumors compromise large vascular structures of the liver, occasionally ex-vivo hepatectomy is needed. Through this approach the liver is explanted from the patient and the tumor is removed and vascular reconstructions needed performed. This technique allows easier and faster removal of the tumor and causing less blood loss. Once the liver is cleared from tumor, is re-implanted back into the patient.
Hepatic artery chemo-infusion (HAI) through a surgically implantable pump
- Mostly implemented for advanced colorectal cancer liver metastasis (CRLM), HAI is a liver directed therapy through which chemotherapy is infused through a titanium implantable pump that has a catheter that is inserted in the hepatic artery.
- Advantage of this form of chemotherapy is that it can be more effective and with less side effects compared to systemic chemotherapy.
- Studies have shown that use of HAI prolonged patient survival when compared to patients in whom HAI was not implemented.
Advanced laparoscopic liver surgery
- Minimally invasive liver surgery has evolved significantly. Its advantage is that post-operative recovery is faster and with less pain. Studies have shown that in selected patients no difference in oncologic outcome has been noticed when compared with traditional open surgery.
- At Cleveland Clinic, state of the art laparoscopic liver surgery is offered to selected patients with various liver tumors.
- Liver transplant is the surgery of choice for patients with cirrhosis and liver tumors. Selected patients with hepatocellular carcinoma, cholangiocarcinoma and liver metastasis from colorectal cancer can be considered for liver transplantation.
- Liver transplantation using living donors offered at Cleveland Clinic is also an advanced and unique alternative treatment for patients with liver tumors.
Locoregional therapies (LRT)
LRT are non-surgical interventions performed by the interventional radiologist, to achieve total tumor destruction or to downsize the tumor
- Stereotactic beam radiation therapy (SBRT).
- Microwave ablation.
Medical oncology treatments
- Diverse systemic chemotherapies and molecular targeted therapies.
Liver tumor embolization
- Embolization is the process of injecting microscopic particles into a branch of the hepatic artery (vessel that provides blood flow to the liver) to block or reduce the blood flow to a tumor in the liver.
- A small cut is made into the skin and a catheter (a thin, flexible tube) is introduced into the artery in front of the hip. Using image guided technology, a catheter is advanced into the hepatic artery in the liver. X-ray dye is injected into the bloodstream to assure proper position. The small particles are then injected into the artery to plug it up, which blocks oxygen and nutrients from getting to the tumor, causing the tumor to die and shrink.
- The catheter is then removed and then either a small device is used to plug up the artery in your groin or pressure is applied to that area to prevent bleeding.
Which treatment is best for you?
Your case will be reviewed by a multidisciplinary team to decide which treatment option will provide the most benefit to you. Treatment decision is based on a number of factors:
- Liver function.
- Location of the tumor/s.
- Size of tumor.
- Tumor spread to other sites other than the liver (metastasis).
- Functional capacity.
Treatment follow up
You will have routine imaging done to monitor the status of your liver cancer. If there is recurrent liver cancer, development of more liver tumors or a suboptimal response to the treatment we may decide that further treatment is needed. Decision is made based on the factors mentioned previously.
For additional information
Appointments & Locations
To schedule an appointment with a Cleveland Clinic liver cancer specialist, please call 216.445.8389.
Videos show graphic content. Please watch at your own disgression.
- Access our free Liver Cancer Treatment Guide
Listen to episodes of Cleveland Clinic's podcast Butts & Guts about liver cancer topics:
- All About Laparoscopic Liver Resection featuring David Kwon, MD, PhD
- All About Liver Cancer featuring Federico Aucejo, MD
Hear the inspiring stories of real Cleveland Clinic patients fighting liver cancer:
- Never give up: Nepalese Man Embarks on a Lifesaving Journey to Treat Bile Duct Cancer
- Marathon Runner Plans Next Race, Thanks to Minimally-Invasive Surgery to Remove Liver Tumor
- Patient and Surgeon Take on Cancer with ‘One Punch’
- Church Bulletin Leads to Priceless Gift in Mother’s Cancer Fight
Find helpful posts from Cleveland Clinic's site for physicians and healthcare professionals. Discover the latest liver cancer research insights, innovations, treatment trends and more:
- Surgery Opens New Possibilities for Treating Liver Metastases from Colorectal Cancer
- Use of Augmented Reality in Microwave Ablation for Liver Cancer
- Hyperfractionated Radiotherapy, Intrabiliary Brachytherapy and Liver Transplant for Localized Perihilar Cholangiocarcinoma
- First Transplant to Treat Liver Metastases from Colorectal Cancer in the U.S.
- Hepatic Artery Chemo-Infusion (HAI) Through Implantable Pump for Colorectal Cancer Liver Metastases
Support & Services
In addition to offering state of the art diagnostic techniques and liver cancer treatment methods, our specialists also offer an array of resources that can help patients cope with the demands of cancer. Patients are encouraged to take advantage of these resources to ease the burden of managing cancer.
Clinical Trials & Research
The goal of our research program is to advance the knowledge on biology of liver, biliary and pancreas malignancy towards personalized medicine, best utilization of current therapies, and therapy discovery.
Through the Cleveland Clinic Cancer Program, patients’ bio-specimens including blood, breath exudate and liver tumor tissue are collected and bio-banked for research purposes. This process is initiated after informed consent is obtained from the patient at the liver tumor clinic.
Innovation and treatment discoveries are pivotal within the mission of the Cleveland Clinic Liver Cancer Program. Some of these endeavors include:
- 3-D printing of liver models and computer software to aid surgical treatments of complex liver malignancies
- Tissue, serum and breath bio-repository for translational research
- Liver malignancy mice xenograft research platform—to study liver tumors from individual patients fostering personalized medicine in the field of liver oncology
Cleveland Clinic Cancer Center clinical trials offer patients important treatment options and access to the latest treatments and procedures resulting from cancer research.
Clinical trials (or research studies) help us create the medicine of tomorrow. They provide hope through offering testing of new drugs, new surgical techniques or other treatments before they are widely available.
We can help you access hundreds of clinical trials across all specialty areas. Our new searchable online trials tool makes identifying treatment opportunities easier than ever.
Cleveland Clinic Cancer Center is committed to working with you to provide the best care for your patients. Our team is also dedicated to the training and education of medical professionals to advance cancer care and research.
- View our For Medical Professionals resources
- View our Liver Cancer research
- View our publications related to Liver Cancer
Make An Online Referral
To make a direct online referral to our Cleveland Clinic Cancer Center, complete our Online Cancer Patient Referral Form or visit clevelandclinic.org/cancerpatientreferrals.
You will receive confirmation once the appointment is scheduled.