National Leader in Treating Liver Cancer
The Center for Liver Disease and Transplantation at NYP/Columbia is making noteworthy progress in the treatment of hepatocellular cancer (HCC) and cholangiocarcinoma (CCA), cancer of the bile duct, as the national leader in this field.
“Although surgery is the only way to achieve a cure, we can also control the tumor without it,” says Tomoaki Kato, MD, Surgical Director of the Center’s Liver Transplantation program. “We are spearheading new non-surgical therapies that can sometimes extend patient survival beyond five years and are in the forefront of clinical trials and research.”
“The CLDT is the only center in the United States to provide the full spectrum of treatment for patients with early to advanced liver cancer,” says Jean C. Emond, MD, Chief of Transplantation Services at Columbia. “Our success is based upon high patient volume and the seamless collaboration of the country’s top surgeons, interventional radiologists and gastroenterologists, and hepatologists. Our multidisciplinary team allows up to provide the best care for all of our patients.”
Joshua Weintraub, MD, Director of Interventional Radiology at Columbia, reports, “In recent years we’ve seen some exciting developments. Microcatheters and wires, improved 3D imaging guidance and novel precision therapy now allow us to deliver treatments that were, until only recently, the dreams of researchers.”
Recent advances include:
Trans-arterial Chemoembolization (TACE)
The CLDT’s interventional radiologists are pioneers in this minimally invasive, image-guided treatment of liver cancer, introducing small catheters to deliver chemotherapy directly to the tumor. This procedure also involves the injection of particles or special gels that block the blood vessels feeding the tumor.
“A steadily growing number of patients afflicted with HCC and CCA are benefitting from the proven potent therapeutic combination of tumor saturating chemo infusion and cancer-choking cessation of blood flow that chemoembolization provides,” says Jonathan Susman, MD, Clinical Director, Vascular and Interventional Radiology at NYP/Columbia. “Advances in the efficacy of the medical devices available and in our ability to pinpoint their delivery with the most sophisticated real-time volumetric imaging available allow these patients to live longer, more productive, symptom free lives.”
Y-90 to Shrink Liver Tumors
When a transplant is needed, chemoembolization and an emerging therapy called Y-90 can help control the tumor until a donor is available. In the latter, small beads (microspheres) containing a radioactive isotope, yttrium-90, are introduced into the hepatic artery. These beads lodge in the blood vessels near the tumor, providing small amounts of radiation to the tumor site for several days. CLDT’s interventional radiologist, David Sperling MD, was one of the first to employ this treatment.
“When surgery is not an immediate option, y-90 and chemoembolization can effectively treat HCC and CCA, on average doubling patient survival,” he reports. “These treatments are also effective against many tumors that start outside the liver and spread there, including colon cancer, breast cancer, pancreatic tumors and many more.”
Portal Vein Embolization (PVE)
PVE induces growth in the liver before a hepatic resection and reduces the risk of complications. “The liver has an amazing ability to regenerate and grow,” says Dr. Sperling. “Using this procedure we block the blood flow to the side of the liver with the tumor and stimulate the side without tumor to expand, sometimes by 25 to 40% in just five weeks. Afterward, patients who would not ordinarily be operable can safely have surgery to remove the tumor.”
PD-1 Inhibitors for Advanced Liver Cancer
Those with advanced HCC can be helped by this new form of immunotherapy, through clinical trials at Columbia. “Immunotherapy has evolved and continues to revolutionize how metastatic melanoma, lung, and kidney cancers are treated. Now early phase clinical trials indicate it may be effective with advanced HCC as well,” says Gulam Manji, MD, PhD, an oncologist at Columbia’s Herbert Irving Comprehensive Cancer Center. “We have multiple active trials involving immunotherapy as a single agent or in combination with other treatments.”
Under the direction of Amrita Sethi, MD, the CLDT’s interventional gastroenterologists place stents in the bile duct to help manage CCA. “Once patients are diagnosed, which can be achieved during ERCP with tissue sampling, stents can be placed to relieve the blockage caused by the tumor,” says Dr. Sethi. “This can immediately relieve jaundice, making patients more comfortable as they await surgery. In addition, special imaging called cholangioscopy utilizing a camera inside the bile duct, can occasionally help guide the extent of surgery.”
Complex Liver Surgery
The CLDT is also known for its success with patients others deem inoperable. As a young émigré from Taiwan in the late 1970s, Jentai Tsai founded the first New York bank for the immigrant community. Forty-five years later, and still hard at work, he was diagnosed with liver cancer. Other doctors had recommended radiation only because of Jentai was in his late 70’s but Dr. Kato knew that without surgery, Jentai would likely be dead within a year. He excised a 10cm liver tumor with wide enough margins to guard against recurrence. Five years later, at 83, Jentai is cancer-free. Read more here
Columbia is a national leader in solid organ transplantation with surgical techniques, replacement organ procurement, and medical management advancing each year. Liver transplant procedures pioneered at the CLDT include living donor transplantation, partial liver transplantation, and advanced organ preservation techniques.
The CLDT is located in uptown Manhattan at 622 West 168th Street and runs a Comprehensive Multidisciplinary Liver Clinic at Columbia Doctors Midtown at 51 West 51st Street.