Liver, Pancreatic, Gallbladder & Bile Duct Cancer Symptoms & Treatment

The Bennett Cancer Center offers exceptional treatment for cancers of the liver, pancreas, gallbladder and bile duct. While these cancers may be less common, they are also often more challenging cancer types to diagnose and treat. Cancer diagnosis and treatment can be a confusing, and sometimes frightening, process. We offer the services of a Nurse Navigator who meets all patients early in their care and provides a familiar face and voice. Furthermore, since liver and pancreatic cancers tend to run in certain families, we also offer the services of a genetic counselor.

• The presenting signs or symptoms of liver, pancreatic or bile duct cancers aren't usually specific.
• You may experience weight loss, abdominal or back pain, discomfort, jaundice (turning yellow) nausea, vomiting, pancreatitis or decreased energy.

At Stamford Health, you'll have access to advanced imaging technology including CT scans with special protocol for studying the pancreas, liver, advanced MRI and state-of-the-art PET scan. In order to give you a more accurate diagnosis, we work with a team of dedicated interventional radiologists that use advanced endoscopic procedures like endoscopic ultrasound and ERCP on a regular basis. Because we know your time counts, we try to reduce your wait as much as possible when it comes to your results.

We may have the option of presenting your case in front of a multidisciplinary tumor board. That means a large panel of expert clinicians, will review your specific situation to recommend the most appropriate course of treatment. Our well trained participants in these conferences include medical oncologists, radiation oncologists, surgical oncologists, dietitian, radiologist, pathologist, interventional radiologist, genetic counselor, and a gastrointestinal nursing navigator.

• Liver cancer/tumor
• Metastatic liver tumors from colorectal cancer, carcinoid tumors, appendix cancer, sarcomas, gastrointestinal stromal tumors (GIST)Bile duct cancer/Cholangiocarcinoma
• Hilar cholangiocarcinoma
• Gallbladder cancer
• Hepatocellular carcinoma
• Pancreas tumor/cancer
• Pancreas mucinous cyst (IPMN, MCN)
• Duodenal cancer/tumor
• Ampullary cancer/tumor
• Small bowel cancer
• Carcinoid tumors of the gastrointestinal tract (primary and metastatic)

Once we confirm your diagnosis, treatment depends on the type and stage of your liver, pancreatic or bile duct cancer. Options usually include surgery, chemotherapy, radiation therapy, interventional radiology procedures or a combination of these treatments.

Sometimes, you may need additional interventions prior to major liver surgery. This could be targeted treatment of the liver with chemotherapy particles (TACE or transarterial chemoembolization for primary liver cancer), or other intervention (portal vein embolization) to grow the side of the liver our surgeons are intending to leave behind. Our interventional radiologists have extensive experience with these procedures and are always part of the decision-making process during multidisciplinary tumor boards.

Radioembolization (Yttrium-90 embolization or selective internal radiation therapy) is used to treat primary (began in the liver) or metastastic (spread from somewhere else) liver cancer.  

All cancers are susceptible to radiation, if high enough doses of radiation can be concentrated in a cancer. External beam radiation is limited because the radiation has to pass through the skin and body wall to reach the targeted cancer, with resultant limitations on dose to avoid damage to surrounding structures. Radioembolization allows for internal delivery of radiation through the arteries supplying the cancer, thereby allowing concentration of high doses of radiation in the cancer with minimal effect on the surrounding healthy tissues.

Radioembolization requires at least two treatment sessions. The first session is a mapping angiogram, where a catheter is passed into the liver artery from the groin and angiography is used to “map out” all the arteries in the liver circulation. A test will also be done to confirm that there is not shunting of blood flow through the liver into the lungs.

The second session is the delivery of the radiation into the liver cancer. The radiation is in the form of a radioactive isotope called Yttrium-90 or Y-90, which is fixed onto tiny glass or resin particles. Once a microcatheter is placed into the artery supplying the cancer, angiography is performed to confirm appropriate position, and the radioactive microspheres are injected into the artery. The blood flow in the artery carries the particles into the cancer, where they lodge and release the radiation directly into the tumor. The radiation causes death of the cancer cells over the next 1-3 months.

Adjuvant or postoperative chemotherapy/radiotherapy are frequently used. Indications for adjuvant therapies are discussed with each patient individually after a finalized pathology report is available and pathologic staging is done. Adjuvant therapies are administered following current standards in the treatment of HPB malignancies. We let patients recover from surgery prior to the administration of any adjuvant therapy.