Liver Transplantation for HCC, CCA, CRLM

Size: px
Start display at page:

Download "Liver Transplantation for HCC, CCA, CRLM"

Transcription

1 Liver Transplantation for HCC, CCA, CRLM Robert J. Porte Professor of Surgery HPB Surgery and Liver Transplantation University Medical Center Groningen Groningen, The Netherlands

2 Liver Transplantation for Malignant Tumors Hepatocellular Carcinoma Cholangiocarcinoma Colorectal liver metastases

3 Liver Transplantation in The Netherlands transplants / year 100 Adults 20 Children International collaboration and sharing via Eurotransplant Leiden Rotterdam Groningen

4 Survival After Liver Transplantation UMCG % year survival 70-80% Years

5 Indications for Liver Transplantation in Europe (n=79,044) 13% for cancer European Liver Transplant Registry

6 Indications for Liver Transplantation Hepato-Biliary Cancers in Europe Metastases 8% Biliary tract cancer 6% HCC 72% Peripheral Cholangioca 5% Others 9%

7 Why Only 13% of Liver Transplantations for Malignancy? There is donor organ shortage We have to deal with the gap between supply and demand and to ensure: Avoidance of death on the waiting list Optimization of outcome and avoidance of futility

8 The Gap Between Donor Liver Supply and Demand

9 Evolution of Indications for Malignancies in Europe ELTR 12/ % 80% 60% 40% 20% 0% Hepatocellular carcinoma : 5622 Cholangiocellular carcinoma : 269 Carcinoma biliary : 256 Metastases : 443 Others : 480

10 Liver Transplantation for Malignant Tumors Hepatocellular Carcinoma Cholangiocarcinoma Colorectal liver metastases

11 Hepatocellular Carcinoma - Epidemiology - Malignant tumor arising from hepatocytes, Most frequent primary hepatic cancer worldwide Third leading cause of cancer mortality worldwide 0.5 to 1 million cases / year worldwide Wide geographic variability Male : Female = 4 : 1

12 Hepatocellular Carcinoma - Etiology - Clear relationship between HCC and cirrhosis 80-90% of all HCC originates in cirrhotic livers Annual risk of developing HCC in cirrhosis: 1-6% All types of cirrhosis are at increased risk

13 Hepatocellular Carcinoma - Treatment Modalities - With curative intent: Partial liver resection Liver transplantation Local ablative therapy radio frequency or microwave ablation (RFA/MWA) Palliative: Sorafinib (tyrosine kinase inhibitor) Transarterial chemoembolization (TACE) Yttrium-90 radioembolization (microspheres)

14 Hepatocellular Carcinoma - Indications for Liver Transplantation - The Milano or Mazzaferro Criteria: Cirrhosis 1 HCC < 5 cm, or 3 HCCs < 3cm Mazzaferro et al. New Engl J Med 1996; 334: Survival after liver transplantation for HCC within these criteria is similar to that for other indications: 70-80% survival at 5-years

15 The Milan Criteria (based on tumor size) are not relevant for HCC in otherwise normal livers Relevant factors: - No macrovascular invasion - No lymph node metastases - > 12 months after primary resection

16 Published Online November 2011

17 Liver Transplantation for Malignant Tumors Hepatocellular Carcinoma Cholangiocarcinoma Colorectal liver metastases

18 Cholangiocarcinoma Incidence 1 per 100,000 / yr In US: ± 3000 new cases / yr Predisposing factors: PSC / ulcerative colitis Inflammation Intrahepatic stone disease Liver flukes ± 10% 60-70% 20-30% Generally divided in: Intrahepatic Perihilar Distal

19 Liver Transplantation versus Resection for Cholangiocarcinoma Resection not possible: Anatomical situation Vascular encasement Bilateral intrahepatic extension Concomitant liver pathology Fibrosis, cirrhosis (PSC) Portal hypertension Potential advantages of transplantation: Most radical resection / full hepatectomy Lower risk of postoperative liver failure No small remnant liver volume No remnant diseased liver tissue (e.g. PSC)

20 Overall Results of Liver Transplantation For Cholangiocarcinoma (ELTR) Low overall 5-year survival: 10-30% High tumor recurrence rate However: Majority had advanced disease: stage III or IV tumors No (neo)adjuvant treatment In the mean time: Better imaging techniques (better selection possible) Lower perioperative mortality More specific immunosuppressive medication Neo-adjuvant chemoradiation protocols

21 Mayo Clinic Protocol Entry Criteria Perihilar cholangiocarcinoma Brush cytology or endoscopic biopsy, or CA19-9 > 100 ng/ml + malignant stricture, without cholangitis Unresectable tumor Tumor diameter 3 cm No intra- or extrahepatic metastases (Stage I or II) CT scan and MRI EUS-guided FNA of regional lymph nodes No prior abdominal radiation therapy No transperitoneal or transgastric biopsy of the primary tumor No prior attempt at resection with violation of the bile ducts

22 Neo-Adjuvant Treatment Protocol External beam radiation therapy 5-Fluorouracil Brachytherapy with Iridium 192 Exploratory laparotomy (20-25% drop out) Capecitabine

23 Survival and Recurrence Following Transplantation for CCA at Mayo Clinic > 1500 patients referred 148 have begun neoadjuvant therapy at Mayo Clinic since 1993 (65% had PSC) 90 had favorable findings at staging laparotomy and underwent transplantation Overall recurrence rate: 17% 5-year survival for all patients that began neoadjuvant therapy: 55% 5-year survival after Tx: 71% 5-year disease free survival: 60% Heimbach, et al. Transplant 2006 Gores, et al. J Hepatol 2007 Rosen, et al. HPB 2008

24 Other Important Unanswered Questions What is more important? Better preoperative staging and selection of only stage I and II? Or neoadjuvant therapy? Nordic experience, without neoadjuvant Rx Spanish multicenter experience without neoadjuvant chemo- or radiotherapy 5 year survival for stage I and II: 47% 5 year survival for stage III and IV: 15% Robles, et al. Ann Surg 2004 Brandsaeter, et al. J Hepatol 2004

25 Liver Transplantation for Cholangiocarcinoma in the Netherlands Accepted indication since 2011 Very strict screening protocol Only stage II or lower Screening according to Mayo Clinic protocol No neo-adjuvant chemo-radiation therapy

26 Liver Transplantation for Malignant Tumors Hepatocellular Carcinoma Cholangiocarcinoma Colorectal liver metastases

27 Liver Transplantation for Colorectal Liver Metastases Currently considered an absolute contraindication ELTR: 55 patients transplanted for CRLM Vienna experience: 24 patients ( ) 5-year survival: 18% Muhlbacher, et al. Transplant Proc 1991; 23: 1567

28 2010 Major advances have been made in the fields of oncological treatment and transplantation since the mid 1990 s. Better chemotherapeutic strategies Better imaging and staging Genetic detection of lymph node micrometastases (Kras, p53)

29 Liver Transplantation for HCC, CCA and CRLM Conclusions Balance between organ demand and supply We have to avoid futility (5-year survival <50%) HCC and CCA are accepted indications for liver transplantation in the Netherlands HCC in cirrhotic liver: within Milan criteria HCC in normal liver: no macrovascular invasion no lymph node metastases or > 12 months after primary resection CCA: Stage II or less (lymph node negative) CRLM: not an indication for transplantation because of low survival rates

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Liver Transplantation for Hepatocellular Carcinoma John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Hepatocellular Carcinoma HCC is the 5th most common

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL HEPATOCELLULAR CARCINOMA GI Site Group Hepatocellular Carcinoma Authors: Dr. Jennifer Knox, Dr. Mairead McNamara 1. INTRODUCTION

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

Surgical Treatment of Various GI Tract Cancers

Surgical Treatment of Various GI Tract Cancers Surgical Treatment of Various GI Tract Cancers By James Ouellette, DO, FACS, Surgical Oncology, Hepatobiliary Surgery Surgical treatment for most gastrointestinal (GI) cancers requires multidisciplinary

More information

Hepatocellular Carcinoma Treatment Decision Tree

Hepatocellular Carcinoma Treatment Decision Tree Treatment Decision Tree Derek DuBay, MD Assistant Professor of Surgery Liver Transplant and Hepatobiliary Surgery UAB Department of Surgery 1 UAB Liver Tumor Clinic Referrals: 205 996 5970 (phone) 205

More information

Treatment of Hepatic Neoplasm

Treatment of Hepatic Neoplasm I. Policy University Health Alliance (UHA) will reimburse for treatment of hepatic neoplasm outside of systemic chemotherapy alone when determined to be medically necessary and within the medical criteria

More information

Hepatocellular Carcinoma Management Guidelines

Hepatocellular Carcinoma Management Guidelines Hepatocellular Carcinoma Management Guidelines By Ashraf Omar M.D, Prof. of Hepatology & Tropical Medicine Cairo University Staging Strategy and Treatment for Patients With HCC HCC PST 0, Child-Pugh A

More information

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH Professor of Medicine Department of Gastroenterology Director, Viral Hepatitis Center University of California San Francisco

More information

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 General Data Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 The vast majority of the patients in this study were diagnosed

More information

Clinical Practice Guidelines for Hepatocellular Carcinoma, List of Clinical Questions/Recommendations. Chapter. Grade. CQ No. 1 Interferon Therapy

Clinical Practice Guidelines for Hepatocellular Carcinoma, List of Clinical Questions/Recommendations. Chapter. Grade. CQ No. 1 Interferon Therapy Clinical Practice Guidelines for Hepatocellular Carcinoma, List of Clinical Questions/Recommendations Chapter Chapter 1 Prevention Sectio n CQ No. 1 Interferon Therapy Clinical Question 1 Does interferon

More information

HEPATOCELLULAR CARCINOMA (HCC) RESECTION VERSUS TRANSPLANTATION. Francis Yao, M.D.

HEPATOCELLULAR CARCINOMA (HCC) RESECTION VERSUS TRANSPLANTATION. Francis Yao, M.D. UCSF TRANSPLANT CONFERENCE - 9/28/2012 HEPATOCELLULAR CARCINOMA (HCC) RESECTION VERSUS TRANSPLANTATION Francis Yao, M.D. Professor of Clinical Medicine and Surgery Medical Director, Liver Transplantation

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: microwave_tumor_ablation 12/2011 11/2015 11/2016 11/2015 Description of Procedure or Service Microwave ablation

More information

CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA

CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA WHAT IS CANCER OF THE LIVER? Hepatocellular carcinoma is the most common form and it comes from the main type of liver cell, the hepatocyte. About 3 out 4

More information

Pancreas Cancer and Neoadjuganoff

Pancreas Cancer and Neoadjuganoff Pancreas & Liver Tumors Boris W. Kuvshinoff, MD MBA Associate Professor of Surgery Director, Liver and Pancreas Tumor Center April 22, 2014 Liver & Pancreas Tumor Center HPB (Hepatopancreaticobiliary)

More information

Non-coronary Brachytherapy

Non-coronary Brachytherapy Non-coronary Brachytherapy I. Policy University Health Alliance (UHA) will reimburse for non-coronary brachytherapy when it is determined to be medically necessary and when it meets the medical criteria

More information

MR imaging of primary sclerosing cholangitis (PSC) using the hepatobiliary specific contrast agent Gd-EOB-DTPA

MR imaging of primary sclerosing cholangitis (PSC) using the hepatobiliary specific contrast agent Gd-EOB-DTPA MR imaging of primary sclerosing cholangitis (PSC) using the hepatobiliary specific contrast agent Gd-EOB-DTPA Poster No.: C-0019 Congress: ECR 2010 Type: Educational Exhibit Topic: Abdominal Viscera (Solid

More information

Lung Cancer Treatment Guidelines

Lung Cancer Treatment Guidelines Updated June 2014 Derived and updated by consensus of members of the Providence Thoracic Oncology Program with the aid of evidence-based National Comprehensive Cancer Network (NCCN) national guidelines,

More information

LIVER TUMORS PROFF. S.FLORET

LIVER TUMORS PROFF. S.FLORET LIVER TUMORS PROFF. S.FLORET NEOPLASM OF LIVER PRIMARY 1)BENIGN 2)MALIGNANT METASTATIC/SECONDARY LIVER Primary Liver Cancer the Second Killer among tumors high morbidity and mortality(20.40/100,000) etiology

More information

Pancreatic Cancer. The Killer that must be discovered early. Dr Alfred Kow Wei Chieh

Pancreatic Cancer. The Killer that must be discovered early. Dr Alfred Kow Wei Chieh Pancreatic Cancer The Killer that must be discovered early 27 th June 2015 Dr Alfred Kow Wei Chieh Consultant Department of Surgery Division of HPB Surgery & Liver Transplantation & Assistant Dean (Education)

More information

Hepatocellular Carcinoma (HCC)

Hepatocellular Carcinoma (HCC) Abhishek Vadalia Introduction Chemoembolization is being used with increasing frequency in the treatment of solid hepatic tumors such as Hepatocellular Carinoma (HCC) & rare Cholangiocellular Carcinoma

More information

Hepatocellular Carcinoma: What the hepatologist wants to know

Hepatocellular Carcinoma: What the hepatologist wants to know Hepatocellular Carcinoma: What the hepatologist wants to know Hélène Castel, MD Liver Unit Hôpital St-Luc CHUM? CAR Annual Scientific Meeting Saturday, April 27 th 2013 Disclosure statement I do not have

More information

LIVER CANCER AND TUMOURS

LIVER CANCER AND TUMOURS LIVER CANCER AND TUMOURS LIVER CANCER AND TUMOURS Healthy Liver Cirrhotic Liver Tumour What causes liver cancer? Many factors may play a role in the development of cancer. Because the liver filters blood

More information

Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence. Cord Sturgeon, MD

Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence. Cord Sturgeon, MD Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence Cord Sturgeon, MD Associate Professor of Surgery Northwestern University Feinberg School of Medicine Director of Endocrine Surgery Chicago,

More information

SBRT (Elekta), 45 Gy in fractions of 3 Gy 3x/week for 5 weeks (N=22) vs.

SBRT (Elekta), 45 Gy in fractions of 3 Gy 3x/week for 5 weeks (N=22) vs. Uitgangsvraag 6: Wat is de plaats van stereotactische radiotherapiebehandeling (SBRT) bij HCC patiënten? Primaire studies I Study ID II Method III Patient characteristics IV Intervention(s) V Results primary

More information

Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines

Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines April 2008 (presented at 6/12/08 cancer committee meeting) By Shelly Smits, RHIT, CCS, CTR Conclusions by Dr. Ian Thompson, MD Dr. James

More information

Yttrium-90 Radioembolization

Yttrium-90 Radioembolization Yttrium-90 Radioembolization Yttrium-90 radioembolization is generally used as a palliative therapy for selected patients with unresectable tumors of the liver including: Metastatic tumors from colorectal

More information

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Carcinoma of the Cervix Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Cervical Cancer Treatment Treatment Microinvasive (Stage IA1): Simple (extrafascial) hysterectomy/cone

More information

BACKGROUND MEDIA INFORMATION Fast facts about liver disease

BACKGROUND MEDIA INFORMATION Fast facts about liver disease BACKGROUND MEDIA INFORMATION Fast facts about liver disease Liver, or hepatic, disease comprises a wide range of complex conditions that affect the liver. Liver diseases are extremely costly in terms of

More information

Name of Policy: Locoregional Therapies for Hepatocellular Carcinoma and Metastatic Liver Carcinoma and Metastatic Carcinoid Tumors of the Liver

Name of Policy: Locoregional Therapies for Hepatocellular Carcinoma and Metastatic Liver Carcinoma and Metastatic Carcinoid Tumors of the Liver Name of Policy: Locoregional Therapies for Hepatocellular Carcinoma and Metastatic Liver Carcinoma and Metastatic Carcinoid Tumors of the Liver Policy #: 070 Latest Review Date: September 2015 Category:

More information

Post-PET Restaging Cancer Form National Oncologic PET Registry

Post-PET Restaging Cancer Form National Oncologic PET Registry Post-PET Restaging Cancer Form National Oncologic PET Registry Facility ID #: Registry Case Number: Patient Name: Your patient had a PET scan on: mm/dd/yyyy. The PET scan was done for restaging of (cancer

More information

What is liver cancer?

What is liver cancer? Liver Cancer What is liver cancer? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines LIVER CANCER: A GUIDE FOR PATIENTS

More information

Liver Resection Versus

Liver Resection Versus ANNALS OF SURGERY Vol. 218, No. 2, 145-151 ) 1993 J. B. Lippincott Company Liver Resection Versus Transplantation for Hepatocellular Carcinoma in Cirrhotic Patients Henri Bismuth, M.D., F.A.C.S. (Hon),

More information

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Neoadiuvant and adiuvant therapy for advanced gastric cancer Franco Roviello, IT Neoadjuvant and adjuvant therapy for advanced

More information

Optimal imaging surveillance schedules after liver directed therapy for hepatocellular carcinoma

Optimal imaging surveillance schedules after liver directed therapy for hepatocellular carcinoma Optimal imaging surveillance schedules after liver directed therapy for hepatocellular carcinoma F. Edward Boas, MD, PhD; Bao Do, MD; John D. Louie, MD; Nishita Kothary, MD; Gloria L. Hwang, MD; William

More information

Interventional Oncology

Interventional Oncology Interventional Oncology 23 September 2014 Imagine where we can go. Forward-looking statement This presentation and information communicated verbally to you may contain certain projections and other forward-looking

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information

Management of Patients with Recurrent Hepatocellular Carcinoma Following Living Donor Liver Transplantation: A Single Center Experience

Management of Patients with Recurrent Hepatocellular Carcinoma Following Living Donor Liver Transplantation: A Single Center Experience Management of Patients with Recurrent Hepatocellular Carcinoma Following Living Donor Liver Transplantation: A Single Center Experience Y. Gunay, N. Guler, M. Akyildiz, O. Yaprak, M. Dayangac, Y. Yuzer,

More information

Treatment Advances for Liver Cancer

Treatment Advances for Liver Cancer Treatment Advances for Liver Cancer Guest Expert: Wasif, MD Associate Professor of Medical Oncology Mario Strazzabosco, MD Professor of Internal Medicine, Digestive Diseases www.wnpr.org www.yalecancercenter.org

More information

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology Mesothelioma 1. Introduction 1.1 General Information and Aetiology Mesotheliomas are tumours that arise from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis [1]. Most are

More information

Leading the Way to Treat Liver Cancer

Leading the Way to Treat Liver Cancer Leading the Way to Treat Liver Cancer Guest Expert: Sukru, MD Professor of Transplant Surgery Mario Strazzabosco, MD Professor of Internal Medicine www.wnpr.org www.yalecancercenter.org Welcome to Yale

More information

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY Dr. Shailesh V. Shrikhande Associate Professor & Consultant Surgeon GI and HPB Surgical Oncology Tata Memorial Hospital, Mumbai INDIA HELICAL

More information

Uitgangsvraag 3: Welke prognostische factoren moeten er beschreven worden in het pa-verslag van het resectiepreparaat

Uitgangsvraag 3: Welke prognostische factoren moeten er beschreven worden in het pa-verslag van het resectiepreparaat Uitgangsvraag 3: Welke prognostische factoren moeten er beschreven worden in het pa-verslag van het resectiepreparaat van HCC patiënten? Primaire studies I Study ID II Method III Patient characteristics

More information

HPB Clinical Guidelines for Pancreatic and Periampullary Cancer, Colorectal Liver Metastases and Primary Liver Cancers 2015 (Lancs & South Cumbria)

HPB Clinical Guidelines for Pancreatic and Periampullary Cancer, Colorectal Liver Metastases and Primary Liver Cancers 2015 (Lancs & South Cumbria) HPB Clinical Guidelines for Pancreatic and Periampullary Cancer, Colorectal Liver Metastases and Primary Liver Cancers 2015 (Lancs & South Cumbria) 1 Pancreatic and Periampullary Cancer (ELHT Ver 4 2015)

More information

Liver Transplantation in Patients with Hepatocellular Carcinoma Across Milan Criteria

Liver Transplantation in Patients with Hepatocellular Carcinoma Across Milan Criteria LIVER TRANSPLANTATION 14:272-278, 2008 ORIGINAL ARTICLE Liver Transplantation in Patients with Hepatocellular Carcinoma Across Milan Criteria J. Ignacio Herrero, 1 Bruno Sangro, 1 Fernando Pardo, 2 Jorge

More information

Update on thyroid cancer surveillance and management of recurrent disease. Minimally invasive thyroid surgery

Update on thyroid cancer surveillance and management of recurrent disease. Minimally invasive thyroid surgery Update on thyroid cancer surveillance and management of recurrent disease Minimally invasive thyroid surgery July 2006 Michael W. Yeh, MD Program Director, Endocrine Surgery Assistant Professor, David

More information

Hepatocellular Carcinoma

Hepatocellular Carcinoma Hepatocellular Carcinoma GI Practice Guideline Michael Sanatani, MD, FRCPC (Medical Oncologist) Walter Kocha, MD, FRCPC (Medical Oncologist) Approval Date: October 2006 This guideline is a statement of

More information

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation

More information

Cancer of the Pancreas

Cancer of the Pancreas Cancer of the Pancreas James H. North Jr., M.D., F.A.C.S. It is estimated that in 2007, 37,170 patients will be diagnosed with cancer of the pancreas and 33,370 patients will die of this disease. 1 The

More information

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Dan Vogl Lay Abstract Early stage non-small cell lung cancer can be cured

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

UCLA Asian Liver Program

UCLA Asian Liver Program CLA Program Update Program Faculty Myron J. Tong, PhD, MD Professor of Medicine Hepatology Director, Asian Liver Program Surgery Ronald W. Busuttil, MD, PhD Executive Chair Department of Surgery Director,

More information

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 6

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 6 Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 6 Contents 6. Hepatocellular carcinoma 64 6.1. Introduction: 65 6.2.

More information

Pancreatic Cancer: FDA Approved Treatments and Clinical Trials

Pancreatic Cancer: FDA Approved Treatments and Clinical Trials Pancreatic Cancer: FDA Approved Treatments and Clinical Trials Vincent J Picozzi MD MMM Virginia Mason Medical Center Seattle WA 1 Pancreatic cancer is the hardest cancer of all to treat 2 Pancreatic cancer:

More information

David R. DeHaas, Jr. MD Sacred Heart Medical Center at RiverBend

David R. DeHaas, Jr. MD Sacred Heart Medical Center at RiverBend David R. DeHaas, Jr. MD Sacred Heart Medical Center at RiverBend 1. To review the surgical history of the Whipple procedure for periampullary tumors. 2. To review the differential diagnosis for patients

More information

CMS does not have a National Coverage Determination for transarterial chemoembolization for primary liver cancer.

CMS does not have a National Coverage Determination for transarterial chemoembolization for primary liver cancer. Subject: Transarterial Chemoembolization (TACE) for Primary Liver Hepatocellular Carcinoma (HCC) Guidance Number: MCG-120 Revision Date(s): Original Effective Date: 10/31/2012 Medical Coverage Guidance

More information

Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus

Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus ANNALS OF SURGERY Vol. 233, No. 3, 379 384 2001 Lippincott Williams & Wilkins, Inc. Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus Masami Minagawa,

More information

Focal Treatment of Liver Metastasis. Bjørn Skjoldbye The Gastro Unit Herlev Hospital

Focal Treatment of Liver Metastasis. Bjørn Skjoldbye The Gastro Unit Herlev Hospital Focal Treatment of Liver Metastasis Bjørn Skjoldbye The Gastro Unit Herlev Hospital The Classic approach: Liver metastasis CRC Resectable? Operable? Chemotherapy Surgery Potential cureable disease Liver

More information

Hepatocellular carcinoma: A comprehensive review

Hepatocellular carcinoma: A comprehensive review Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.4254/wjh.v7.i26.2648 World J Hepatol 2015 November 18; 7(26): 2648-2663 ISSN 1948-5182 (online)

More information

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background Imaging of Pleural Tumors Mylene T. Truong, MD Imaging of Pleural Tumours Mylene T. Truong, M. D. University of Texas M.D. Anderson Cancer Center, Houston, TX Objectives To review tumors involving the

More information

Cancer: Pancreatic (Adult)

Cancer: Pancreatic (Adult) A02/S/b 2013/14 NHS STANDARD CONTRACT FOR CANCER: PANCREATIC (ADULT) SECTION B PART 1 - SERVICE SPECIFICATIONS Service Specification No. Service Commissioner Lead Provider Lead Period Date of Review A02/S/b

More information

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity

More information

Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases

Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases I Congresso de Oncologia D Or July 5-6, 2013 Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University

More information

Benign Liver Tumors. Cameron Schlegel PGY-1 3/6/2013

Benign Liver Tumors. Cameron Schlegel PGY-1 3/6/2013 Benign Liver Tumors Cameron Schlegel PGY-1 3/6/2013 Outline Benign Liver Tumors are, in general. Asymptomatic Diagnosed: imaging Treatment: Do no harm Unless Malignant potential Causing symptoms Differential

More information

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases.

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Abstract This paper describes the staging, imaging, treatment, and prognosis of renal cell carcinoma. Three case studies

More information

Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer)

Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer) Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer) Presumptive Cancers Due to Agent Orange Exposure Prostate Cancer - Cancer of the prostate; one of

More information

Hepatocellular Carcinoma: A Guide to Screening and Diagnosis

Hepatocellular Carcinoma: A Guide to Screening and Diagnosis February 2012 Hepatocellular Carcinoma: A Guide to Screening and Diagnosis Reid Merryman, Harvard Medical School Year III Agenda Hepatocellular carcinoma (HCC) introduction Index patient: clinical presentation

More information

Locoregional & advanced esophagus or esophagogastric junction cancer

Locoregional & advanced esophagus or esophagogastric junction cancer Eloxatin (oxaliplatin) Prior Authorization Request (For Maryland Only) Send completed form to: Case Review Unit CVS/caremark Specialty Programs Fax: 866-249-6155 CVS/caremark administers the prescription

More information

A912: Kidney, Renal cell carcinoma

A912: Kidney, Renal cell carcinoma A912: Kidney, Renal cell carcinoma General facts of kidney cancer Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type

More information

Evidence tabel Lokaal palliatieve behandelingen

Evidence tabel Lokaal palliatieve behandelingen Auteurs, jaartal Mate van bewijs Studie type Follow-up Populatie (incl. steekproef-grootte) Patienten kenmerken Interventie Controle Resultaten Conclusie Opmerkingen, commentaar Hartgrink, 2002 The Netherlands

More information

Lenox Hill Hospital Department of Surgery General Surgery Goals and Objectives

Lenox Hill Hospital Department of Surgery General Surgery Goals and Objectives Lenox Hill Hospital Department of Surgery General Surgery Goals and Objectives Medical Knowledge and Patient Care: Residents must demonstrate knowledge and application of the pathophysiology and epidemiology

More information

National Medical Policy

National Medical Policy National Medical Policy Subject: Policy Number: Ablation of Liver Tumors NMP124 Effective Date*: March 2004 Updated: February 2015 This National Medical Policy is subject to the terms in the IMPORTANT

More information

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum OVERVIEW OF THE FELLOWSHIP The goal of the AASLD NP/PA Fellowship is to provide a 1-year postgraduate hepatology training program for nurse practitioners and physician assistants in a clinical outpatient

More information

Malignant Mesothelioma State of the Art

Malignant Mesothelioma State of the Art Malignant Mesothelioma State of the Art Paul Baas The Netherlands Cancer Institute August 12, 2011, Carlsbad, CA Summary Diagnosis; epithelial type subdivided Pleiomorphic vs other Staging: IASLC-IMIG

More information

Hepatocellular carcinoma: ESMO ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Hepatocellular carcinoma: ESMO ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up Annals of Oncology 23 (Supplement 7): vii41 vii48, 2012 doi:10.1093/annonc/mds225 Hepatocellular carcinoma: ESMO ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up C. Verslype 1,2,

More information

Hepato-pancreato-biliary and liver transplant services

Hepato-pancreato-biliary and liver transplant services Hepato-pancreato-biliary and liver transplant services Introduction The Royal Free Hospital in London is one of the most prestigious medical institutions in the United Kingdom and is a leading centre for

More information

Targeted Therapy What the Surgeon Needs to Know

Targeted Therapy What the Surgeon Needs to Know Targeted Therapy What the Surgeon Needs to Know AATS Focus in Thoracic Surgery 2014 David R. Jones, M.D. Professor & Chief, Thoracic Surgery Memorial Sloan Kettering Cancer Center I have no disclosures

More information

Medical Marijuana Use in Patients with History of SCCHN Treated with Radiotherapy

Medical Marijuana Use in Patients with History of SCCHN Treated with Radiotherapy HEALTH SERVICES RESEARCH Assessment the Impact of Real-time Tumor Tracking & Reduced Planning Target Volume Margins on Quality-of-Life in Prostate Cancer Patients Treatment with Intensity Modulated Radiotherapy

More information

190.25 - Alpha-fetoprotein

190.25 - Alpha-fetoprotein Other Names/Abbreviations AFP 190.25 - Alpha-fetoprotein Alpha-fetoprotein (AFP) is a polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring the response of certain

More information

Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases

Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases M. Trauner, Division of Gastroenterology and Hepatology, Department of Internal Medicine, MUG Co- Investigator: H. Samonigg,

More information

The Actual Five-year Survival Rate of Hepatocellular Carcinoma Patients after Curative Resection

The Actual Five-year Survival Rate of Hepatocellular Carcinoma Patients after Curative Resection Yonsei Medical Journal Vol. 47, No. 1, pp. 105-112, 2006 The Actual Five-year Survival Rate of Hepatocellular Carcinoma Patients after Curative Resection Jae Gil Lee, 1,2 Chang Mu Kang, 1 Joon Seong Park,

More information

Diagnosis and Prognosis of Pancreatic Cancer

Diagnosis and Prognosis of Pancreatic Cancer Main Page Risk Factors Reducing Your Risk Screening Symptoms Diagnosis Treatment Overview Chemotherapy Radiation Therapy Surgical Procedures Lifestyle Changes Managing Side Effects Talking to Your Doctor

More information

J Clin Oncol 24:2897-2902. 2006 by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 24:2897-2902. 2006 by American Society of Clinical Oncology INTRODUCTION VOLUME 24 NUMBER 18 JUNE 20 2006 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Perioperative CA19-9 Levels Can Predict Stage and Survival in Patients With Resectable Pancreatic Adenocarcinoma

More information

Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate e P rofessor Professor Radiation Oncology

Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate e P rofessor Professor Radiation Oncology Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate Professor Radiation Oncology Disclosure Information I have no financial relationships to disclose relevant to the conten of this presentation.

More information

Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科

Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科 Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科 Papillary microcarcinoma of thyroid Definition latent aberrant thyroid occult thyroid carcinoma latent papillary carcinoma)

More information

The evolution of rectal cancer therapy. Objectives

The evolution of rectal cancer therapy. Objectives The evolution of rectal cancer therapy Hagen Kennecke MD MHA FRCPC Western Canada Consensus Conference September 5, 2014 Objectives Identify standard therapy: stage II/III rectal cancer Update recent adjuvant

More information

Clinical Management Guideline Management of locally advanced or recurrent Renal cell carcinoma. Protocol for Planning and Treatment

Clinical Management Guideline Management of locally advanced or recurrent Renal cell carcinoma. Protocol for Planning and Treatment Protocol for Planning and Treatment The process to be followed in the management of: LOCALLY ADVANCED OR METASTATIC RENAL CELL CARCINOMA Patient information given at each stage following agreed information

More information

UK Guidelines for the management of suspected hepatocellular carcinoma (HCC) in adults

UK Guidelines for the management of suspected hepatocellular carcinoma (HCC) in adults UK Guidelines for the management of suspected hepatocellular carcinoma (HCC) in adults SD Ryder DM FRCP Consultant Hepatologist Queens Medical Centre Nottingham University Hospitals NHS Trust Wolfson Digestive

More information

clinical practice guidelines

clinical practice guidelines Annals of Oncology 21 (Supplement 5): v59 v64, 2010 doi:10.1093/annonc/mdq166 Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up S. Jelic 1 & G. C. Sotiropoulos

More information

THYROID CANCER. I. Introduction

THYROID CANCER. I. Introduction THYROID CANCER I. Introduction There are over 11,000 new cases of thyroid cancer each year in the US. Females are more likely to have thyroid cancer than men by a ratio of 3:1, and it is more common in

More information

How To Treat A Uterine Sarcoma

How To Treat A Uterine Sarcoma EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition 2001 Uterus: Uterine Sarcomas Jeffrey L. Stern, MD Uterine sarcomas

More information

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma August 2009 To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma Christina Ramirez, Harvard Medical School Year III Gillian Lieberman, MD Agenda

More information

Hepatocellular carcinoma: Dutch guideline for surveillance, diagnosis and therapy

Hepatocellular carcinoma: Dutch guideline for surveillance, diagnosis and therapy REVIEW Hepatocellular carcinoma: Dutch guideline for surveillance, diagnosis and therapy F.A.L.M. Eskens 1 *, K.J. van Erpecum 5, K.P. de Jong 7, O.M. van Delden 8, H.J. Klumpen 9, C. Verhoef 2, P.L.M.

More information

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto PREVENTION OF HCC BY HEPATITIS C TREATMENT Morris Sherman University of Toronto Pathogenesis of HCC in chronic hepatitis C Injury cirrhosis HCC Injury cirrhosis HCC Time The Ideal Study Prospective randomized

More information

Guidelines for Management of Renal Cancer

Guidelines for Management of Renal Cancer Guidelines for Management of Renal Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Changes Between Versions 2 and 3 Section 5 updated bullets 5.3 and 5.4 Section 6 updated

More information

Section: Medicine Last Reviewed Date: August 2015. Policy No: 140 Effective Date: September 1, 2015

Section: Medicine Last Reviewed Date: August 2015. Policy No: 140 Effective Date: September 1, 2015 Medical Policy Manual Topic: Radioembolization for Primary and Metastatic Tumors of the Liver Date of Origin: December 2, 2010 Section: Medicine Last Reviewed Date: August 2015 Policy No: 140 Effective

More information

Hepatobiliary Cancers

Hepatobiliary Cancers NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Hepatobiliary Cancers Version 2.2013 NCCN.org Continue Version 2.2013 08/21/13 National Comprehensive Cancer Network, Inc. 2013, All rights

More information

Bile Duct Diseases and Problems

Bile Duct Diseases and Problems Bile Duct Diseases and Problems Introduction A bile duct is a tube that carries bile between the liver and gallbladder and the intestine. Bile is a substance made by the liver that helps with digestion.

More information

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Bridging Techniques What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Associate Professor of Surgery Assistant Program Director, General Surgery Residency Disclosures

More information

Hosts. New Methods for Treating Colorectal Cancer

Hosts. New Methods for Treating Colorectal Cancer Hosts Anees Chagpar MD Associate Professor of Surgical Oncology Francine MD Professor of Medical Oncology New Methods for Treating Colorectal Cancer Guest Expert: Scott, MD Associate Professor in the Department

More information