Online Health Chat with Melissa Watson, MD
February 9, 2016
Liver cancer can only be cured if it is found early, before it has spread, and if a patient is healthy enough for surgery. There are certain factors that can affect treatment and prognosis for a person with liver cancer. These factors include the person’s general health, the way that the liver itself is functioning, the stage of the cancer, and the levels of alpha-fetoproteins. Once a comprehensive diagnosis is made and the cancer is staged, surgery is often the primary method of treatment prescribed. Possible surgical options include:
- Cryosurgery or cryotherapy
- Radiofrequency ablation
- Partial hepatectomy
- Total hepatectomy and liver transplant
Cleveland Clinic Florida is currently the only facility in South Florida to offer a multidisciplinary Liver Tumor Clinic comprised of hepatologists, radiologists, oncologists, liver and transplant surgeons, interventional radiologists, and specialized nurse coordinators. These experts work together to develop comprehensive treatment plans for patients diagnosed with either benign or malignant liver tumors to preserve their liver function and quality of life. Our transplant program in Florida, launched in 2013, is an important component of a broad medical and surgical strategy aimed at providing patients with liver disease with treatment options best suited to their individual needs.
About the Speakers
Melissa J. Watson, MD is a Transplant and Hepatobiliary Surgeon in the Transplantation Center at Cleveland Clinic Florida. Dr. Watson received her medical degree from Abilene Christian University and her Masters from Vanderbilt University College of Medicine. She completed her residency at UCLA Medical Center and her fellowship training at Cleveland Clinic in Ohio. Dr. Watson is board-certified and specializes in Liver Transplantation, Kidney Transplantation, Hepatobiliary Surgery, Liver Tumors, Hepatocellular Carcinoma, Hepatitis C, Hepatitis B, Immunosuppression and Organ Donation.
Let’s Chat About Surgical Options for Liver Cancer
Welcome to our Online Health Chat “Surgical Options for Liver Cancer" with Melissa Watson, MD. We are thrilled to have her here today for this chat. Let’s begin with the questions.
Diagnosis and Management of Liver Disease
CCF: My mom was having stomach pains after an ultrasound it was discovered she has a cyst on her liver. She still has the stomach pains. Should she get the cyst removed? Or are there foods she can eat to clean the liver so the cyst can dissolve?
Melissa_J._Watson,_MD: Liver cysts are not usually painful and are not usually removed, unless large and/or compressing another structure. Her stomach pains can be due to any number of things and the pain should be evaluated further. There are no foods or medications to take to get rid of a liver cyst.
johnrf2000jrf: I am a 63 year old male. In the past 6 months I have had high and rising Total Bilirubin readings, the most recent being 1.4. My other liver function results were in the normal range and I have no symptoms. My alcohol consumption was very moderate before this turn of events and I have totally abstained from alcohol since then. My general practitioner recommended an ultrasound, which was performed in November, 2015 and showed several hemangiomas. An MRI was recommended and was performed later that same month. It showed several hemangiomas, a regular cyst and an irregular cyst. My general practitioner suggested that we wait 4 months or so, do more blood work and another ultrasound. The blood work has been preliminarily scheduled for mid-March of this year. Does this seem like a reasonable approach or do you think that these circumstances are concerning enough that I should see a Gastroenterologist immediately? Thank you for your help.
Melissa_J._Watson,_MD: MRI is the best imaging modality for liver lesions, so if it only shows hemangioma and cyst that is reassuring. Repeat imaging in 4 months is reasonable, especially if you have no risk factors for liver cancer such as cirrhosis or hepatitis C or B. Mild elevations in bilirubin can be due to a variety of reasons including Gilbert's disease. Consultation with a GI for elevated bilirubin is also reasonable to do at this point.
Joyce1: My 37-y-o son has been diagnosed with cirrhosis of the liver. This is post Hepatitis B, detected at 18 years of age when he was asymptomatic. Does cirrhosis of the liver ultimately result in liver cancer? Is this detected by an MRI? What are the various options for treatment when the cancer is newly detected after a series of ultrasounds every few months? He is currently on an anti-viral medication. I don't know the name but will try and find out before the web chat tomorrow.
Melissa_J._Watson,_MD: Cirrhosis and chronic viral hepatitis are the most common pre-disposing factors to developing liver cancer (hepatocellular carcinoma), but not every person with cirrhosis develops liver cancer. All cirrhotic patients should have screening imaging every 6 months to evaluate for possible development of liver cancer. Depending on the size and location of tumors, liver-directed therapy can be performed by an Interventional Radiologist if the patient is not a surgical candidate. The patient may also be a candidate for liver transplantation when they start developing tumors in a cirrhotic liver.
Hat: What is hepatitis C and B?
Melissa_J._Watson,_MD: Hepatitis B and C are viruses that can persist in the liver causing chronic liver injury and eventual cirrhosis. For more information about these conditions, please visit our health information website at health.clevelandclinic.org.
LMM321: I've been recommended for a liver transplant. I know that I need to get on a wait list for the surgery. How do I get the donor liver for a transplant?
Melissa_J._Watson,_MD: Deceased donors are distributed in the USA according to the MELD system (Model for End-stage Liver Disease). MELD score is calculated based on laboratory values: total bilirubin, INR, and creatinine. There are certain conditions that merit exception points such as hepatocellular carcinoma. You could also potentially be a candidate for living donation if someone you know is a match for you. The Cleveland Clinic is one of the transplant centers performing living donation liver transplantation. For more information about living donor transplants, please visit our website at clevelandclinicflorida.org/transplant.
DianaDisney80: Is a liver transplant the preferred method of treatment for liver cancer? Can it be treated surgically without having a transplant?
Melissa_J._Watson,_MD: The primary effective treatment for liver cancer is surgery. If someone has a normal liver and is fit enough for surgery, they can have surgery to remove it. Liver surgery can also be performed in some patients with abnormal liver function but in select circumstances. Liver transplantation is generally reserved for patients who have cirrhosis.
Joyce1: If one has a liver transplant what might the side effects be from the anti-rejection drugs that are needed to be taken?
Melissa_J._Watson,_MD: There are many different medications used for immunosuppression after transplant and each of them have a different side effect profile. In general these medications suppress the immune system and can increase risks of developing infection. You can look up a specific medication on the fda.gov website in the Index to Drug-Specific Information section.
Other Surgical Treatments for Liver Cancer
Basketball225: What is a partial hepatectomy? Is it less invasive than other types of liver surgery?
Melissa_J._Watson,_MD: Partial hepatectomy is removal of a portion of the liver. It can be done laparoscopic or as an open operation, depending on the location and size of what needs to be removed.
JoseLuis1208: What is the difference in treatment options for stage 2 liver cancer vs stage 4?
Melissa_J._Watson,_MD: For stage 2 hepatocellular carcinoma (HCC) surgery or liver-directed therapy (such as transarterial chemoembolization [TACE] or radioembolization [TARE]) can be utilized depending on the size, location, and number of tumors. With stage 4 disease the cancer is outside the liver and surgery would not generally be pursued at that point. We use systemic treatments with metastatic HCC such as sorafenib and experimental use of nivolumab. Some centers also have some research trials using immunotherapy.
Carolina1009: What is the difference between an ablation and an embolization?
Melissa_J._Watson,_MD: Ablation generally refers to radiofrequency ablation or microwave ablation using energy (heat).
Embolization can be transarterial chemoembolization or transarterial radioembolization and involve 1) blocking the blood flow in the arteries supplying a liver tumor, and 2) delivering either chemotherapy or radioactive particles directly to the tumor.
DMA89: Does the position of the cancer in my liver affect my surgical options?
Melissa_J._Watson,_MD: Yes, definitely. Surgery of the liver is based on the segmental anatomy of the liver (arrangement of the arteries, veins, and bile ducts). The amount of liver that needs to be removed may be a small amount, or up to 75% of the liver in certain cases.
To make an appointment with Melissa Watson, MD, Transplant and Hepatobiliary Surgeon or any of the other specialists in the Transplantation Center at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at my.clevelandclinic.org/florida.
For More Information On Cleveland Clinic Florida
Cleveland Clinic Florida, located in Weston, West Palm Beach, Atlantis, Palm Beach Gardens and Parkland, is a not-for-profit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic Florida has 240 physicians with expertise in 35 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Florida ranked third among the 66 best hospitals in the Miami-Fort Lauderdale metro area and ninth in Florida in US News & World Report’s 2015-2016 ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose.
For more information about Cleveland Clinic Florida, visit my.clevelandclinic.org/florida.
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