Liver & Biliary Diseases


Liver & Biliary Diseases

Advanced care for hepatocellular carcinoma

Liver Cancer

Integrated Cancer Care Using the Latest Treatments

At NewYork-Presbyterian's Center for Liver Disease and Transplantation, people with liver cancer (hepatocellular carcinoma) benefit from a team of healthcare professionals with exceptional experience diagnosing and treating benign and malignant liver tumors and liver metastases (cancers that spread to the liver from other sites). Some patients with early-stage liver cancer are excellent candidates for liver cancer surgery or liver transplantation. We also offer clinical trials of promising new treatment approaches to advance the field and to raise the survival rate of people with advanced liver cancer and liver metastases. Our ultimate goal is to cure your cancer and maintain your quality of life.

What causes liver cancer?

NewYork-Presbyterian has a strong surveillance program for people at risk of liver cancer, with the hope of detecting the disease in its early, more curable stages. Your risk of developing liver cancer may be elevated if you have:

  • Cirrhosis from any cause
  • Chronic hepatitis B
  • Chronic hepatitis C
  • Chronic hepatitis D
  • A history of heavy alcohol use
  • Excessive exposure to aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly)
  • Fatty liver disease
  • A history of cigarette smoking
  • Certain inherited disorders that damage the liver, such as hemochromatosis, alpha-1 antitrypsin deficiency, or Wilson’s disease

Signs & Symptoms of Liver Cancer

Liver cancer in its earliest stages — when it is most curable — causes no symptoms. This is why screening for individuals at high risk of this cancer is so critical. Liver cancer in later stages can cause symptoms such as:

  • Abdominal pain or swelling
  • Pain in the back or right shoulder blade
  • Jaundice (yellowing of the skin or the whites of the eyes)
  • Easy bruising or bleeding
  • Fatigue (feeling tired)
  • Nausea/vomiting
  • Loss of appetite
  • Unexplained weight loss
  • Dark urine
  • Pale stools
  • Fever

How We Diagnosis Liver Cancer

We use the following tests to diagnose liver cancer:

  • Physical exam
  • Blood tests for certain proteins that may signal liver cancer and to assess liver function
  • Imaging tests such as CT or MRI scanning and ultrasound
  • Liver biopsy if required to assess for cancer that has not started in the liver

Our Approach to Care

Our liver cancer team is multidisciplinary and includes hepatologists, gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, nurses, and other specialists known for providing leading medical, surgical, and supportive care for people with liver cancer. We will assemble a personalized team of healthcare professionals to care for you. We work together to review your testing, imaging results, and progress as a group. All of the healthcare providers you need are available to you through one medical center, which shares combined clinics and conferences.

To support quality of life in individuals with advanced liver cancer, we offer palliative care, which includes services such as pain management.  For all patients with liver cancer, our nutritionists, social workers, palliative care experts, and others will help you and your loved ones address the effects of cancer and its treatment — physical, emotional, and spiritual. We understand the burden cancer can place on your life and the lives of your loved ones, and we do whatever we can to lessen that burden.

Care for people with liver cancer

When planning your treatment, we consider the type, location, and stage of your liver cancer, as well as your age and physical health.

Surgery is the preferred treatment for operable liver cancer and offers the best chance for a long-term cure. Our surgeons use minimally invasive laparoscopic and robotic techniques for liver surgery whenever possible. If you have early-stage liver cancer, you may also be able to have a liver transplant. If you cannot have transplantation, you may be able to undergo removal of part of the liver to treat your cancer.

Embolization therapies. You may receive "loco-regional" therapy to treat the tumor, such as chemoembolization, radiofrequency ablation, or radioembolization.

  • Chemoembolization delivers chemotherapy directly into the tumor through a temporary catheter (narrow tube) into the main liver artery. The chemotherapy is combined with a substance that blocks blood flow to the tumor. Chemotherapy can sometimes reduce the size of a tumor enough that it can be surgically removed.
  • Radiofrequency or microwave ablation is a minimally invasive treatment that applies heat through a probe to destroy cancer cells in small liver tumors (less than one and a half inches in diameter).
  • Radioembolization delivers tiny spheres of cancer-killing radiation (yttrium-90) to the tumor via the main liver artery.

Radiation therapy. We use intensity-modulated radiation therapy (IMRT), which enables us to deliver precisely targeted radiation directly to the tumor while sparing nearby healthy tissue, as well as stereotactic body radiotherapy (SBRT) to deliver pencil-thin beams of radiation to target cancer.

Targeted medical therapy. Targeted therapies specifically aim at cancer cells by interfering with growth factors or impeding the growth of the blood vessels that a tumor needs, while sparing healthy cells. Targeted therapies for primary liver cancer include sorafenib, lenvatinib,  and bevacizumab.

Immunotherapy. Treatments such as atezolizumab boost the immune system's ability to detect and destroy liver cancer cells.

Advanced interventional endoscopy. Blockage of the bile duct is a potential complication of liver tumors, previous liver surgery, and bile duct cancer. Our interventional endoscopists are known for their expertise in the use of endoscopic retrograde cholangiopancreatography (ERCP) to treat bile duct obstructions, relieving pain and other symptoms.

Investigational therapies. Weill Cornell Medicine and Columbia University investigators are conducting clinical trials assessing promising liver cancer treatments. Your team will let you know if you are eligible for a clinical trial.

Expertise in treating liver metastases

The liver is a common site for cancer cells to travel to from other sites, such as the colon and breast. We have strong expertise in the treatment of liver metastases, especially those from colorectal cancer. We offer the latest approaches to improve the quality of life and extend survival.

Surgery. Advances in surgical tools and techniques, better imaging, and a better understanding of liver anatomy now make it possible for our surgeons to remove up to 75 percent of colorectal liver metastases while leaving the remaining healthy liver tissue to regenerate itself. Whenever possible, our liver surgeons remove metastases using minimally invasive laparoscopy or robotic surgery. In conjunction with newer chemotherapy regimens and enhanced interventional radiology techniques, we have pushed the limits of surgery, and a growing number of patients with liver metastases whose tumors were once considered inoperable can now undergo surgery.

Systemic and intra-arterial chemotherapy. You may receive anticancer drugs intravenously (by vein) or by direct infusion into the main liver artery.

Radiation therapy. Your doctors will let you know if you could benefit from radiation therapy with IMRT or SBRT to destroy liver metastases.

Liver transplantation. Certain patients who are not eligible for surgery to remove liver metastases can now have liver transplantation. Liver transplantation in the right patient can help you live longer with metastatic colorectal cancer.

Why Choose Us

The liver is a complex organ, and liver cancer can be very challenging to treat. Whether you have cancer that started in the liver or liver metastases from another cancer, we can tailor a plan of care with the goal of curing or controlling your cancer, relieving your symptoms, and improving your quality of life. There are many advanced approaches now available to manage liver tumors, from tumor-directed therapies to liver transplantation, and they are not widely available at all hospitals. At NewYork-Presbyterian, you have access to all of these innovative approaches, which are provided by physicians and surgeons with exceptional experience and expertise. Contact us today to make an appointment for a consultation and learn how we can help you.

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NewYork-Presbyterian/Columbia University Irving Medical Center

Center for Liver Disease & Transplantation

NewYork-Presbyterian/Weill Cornell Medical Center

Gastroenterology & Hepatology

NewYork-Presbyterian/Columbia University Irving Medical Center

Columbia New Patient Access

NewYork-Presbyterian/Weill Cornell Medical Center

Division of Liver Transplantation, Hepatobiliary and Pancreatic Surgery

Ask about our Liver Cancer & Pancreatic Cancer Multidisciplinary Clinic Programs