Washington University board-certified cancer specialists at Barnes-Jewish Hospital are shaping the way liver cancer patients are cared for through a multidisciplinary approach, clinical innovation and research. Our patients benefit from among the highest survival rates after liver resection in the country and the highest reported results in the world due to our Positron Emission Tomography (PET) scanning facility.
A regional referral center for liver cancer, Barnes-Jewish Hospital is one of the top centers in the country for hepatobiliary procedures. Evidence from clinical studies shows that patients treated in centers that specialize and have a depth of experience have better outcomes.
FOR AN APPOINTMENT, CALL NUMBERS LISTED BELOW
Regional/National Referrals
We treat many patients from outside the region and outside United States. For North American referrals, physicians may call the Barnes-Jewish Hospital Doctors Access Line at (800) 252-DOCS (3627).
Patients in the continental United States may refer to Family and Guest Services for assistance with lodging.
International Referrals
Physicians and patients from countries outside of the United States may view a complete list of our Centers of Excellence available for International Healthcare Referrals or physicians may contact us by email, with a short summary of the patient's diagnosis and your initial treatment plan. We will forward this summary to the right department for review and follow-up. Although English is preferred, you may email in your own language.
SPECIALISTS WHO TREAT:
Medical Oncologist:
Joel Picus, M.D. - Phone (314) 747 1367
Hepatobiliary Surgeons:
David Linehan, M.D. -
Phone (314) 747 2938
Steven M. Strasberg, M.D. - Phone (314) 362 7147
Radiation Oncologists;
Robert Myerson, M.D., PhD - Phone (314) 454 7236
Wade Thorstad, M.D. - Phone (314) 362 7030
Our physicians care for patients before, during and after treatment. The majority of our physicians also are active researchers involved in clinical trials surrounding a variety of issues relevant to hepatobiliary cancer and disease.
COMMONLY ASKED QUESTIONS ABOUT LIVER CANCER
What is primary liver cancer ?
Primary liver cancer is that which originates in the liver itself. The two most common types of liver cancer are primary liver cancers called hepatocellular carcinoma or hepatoma, and cholangiocarcinoma.
Hepatocellular carcinoma (HCC) arises from the liver cells that make the bile, complex sugars, fats and proteins. It occurs most frequently in people who have underlying liver disease or who are cirrhotic - traits most common in people of East Asian origin.
Cholangiocarcinoma is also called bile duct cancer or inter-hepatic bile duct cancer because it is inside the liver.
What is secondary liver cancer ?
A much larger group of liver cancer is called secondary liver cancers because they originate in other parts of the body and metastasize to the liver. Secondary liver cancer usually originates in the large intestine, from the colon and the rectum.
Washington University cancer specialists are expert in treating all types of liver cancer, from the
rarest lesions to the most challenging cases. Due to the population mix in the Midwest, the majority of individuals cared for at Barnes-Jewish Hospital are treated for cholangiocarcinomas and secondary liver cancers.
How is liver cancer diagnosed ?
Liver cancer is one of the more rare types of cancer. With liver cancer, patients may experience typical cancer symptoms like a mass with weight loss, loss of appetite, abdominal pain, weakness or fatigue, or other signs and symptoms related to cancer. In more advanced cases, symptoms of jaundice, a yellowing of the skin and eyes, may also appear.
To diagnose liver cancer, your doctor will review your medical history, your family's health history and conduct a physical exam. Your exam might include: a computed tomography (CT) scan, an X-ray which uses a computer to provide an image of the inside of the abdomen; a magnetic resonance imaging (MRI) scan, which uses magnetic waves to create the image; or an ultrasound, which uses high-frequency sound waves to echo off the body and create a picture.
More advanced imaging tools - particularly PET scanning and intra-abdominal ultrasound - offer a great advantage to patients cared for at Barnes-Jewish Hospital enabling our physicians to detect tumors at an earlier stage and to detect tumors outside the liver. PET studies metabolic activity or body function. These leading imaging tools have eliminated surgeries in which removing the liver would not benefit the patient.
Sometimes a biopsy is performed in which a tiny sample of the liver tissue is examined under a microscope.
How is liver cancer treated ?
Surgery is the most common procedure used to treat liver cancers. The kind of operation depends on the type and extent of the cancer. Surgery will include removal of lymph nodes near the tumor.
Our specialists have found that aggressive treatment strategies can cure or significantly prolong the lives of many patients with liver cancer. This attitude has resulted in on of the highest survival rates after liver resection in the country, and the highest reported results in the world due to the PET scanning facility.
Implantable pump - One method is to implant a pump into the liver at the time of resection to deliver chemotherapy from inside the body after surgery. Research shows that the implantable pump is an innovation in liver cancer treatment that greatly benefits patient survival.
Cryotherapy and radio frequency ablation - The use of cryotherapy and radio frequency ablation of tumors are other therapies used to destroy tumors without surgical removal. Cryotherapy uses extreme cold to destroy tumors and radio frequency ablation uses extreme heat. The doctor may use one of these treatments or a combination of them, depending on the type of cancer found. Alcohol injection into tumors may also be used.
Chemotherapy and radiation - These methods may be used in patients for whom surgery is not an option. Chemotherapy uses drugs to kill cancer cells and may be administered orally, by injecting it into a vein (intravenously), or by injecting it into an artery (intra-arterially). Radiation therapy is the use of high-powered X-rays to kill cancer cells and shrink tumors. Typically given daily over a period of weeks, radiation therapy is not painful. Although stomach irritation may occur, the latest in 3-D treatment planning nearly eliminates this discomfort.
Embolization - Washington University is among a handful of centers in the country now using a technique called embolization - the process of injecting a foreign substance into the tumor to stop the blood flow. The lack of blood deprives the tumor of needed oxygen and nutrients, eventually causing cells to die and the other part of the liver to grow. The use of embolization enables surgeons to remove a much larger part of the diseased liver because the size of normal liver has grown larger.
What is the Washington University advantage ?
The Siteman Cancer Center, located at Barnes-Jewish Hospital is one of the region's most comprehensive centers dedicated exclusively to patients with cancer.
Many services are available to support patients through the treatment decision process and assist them through the various treatment options. A variety of clinical trials are available for consideration of patients who wish to pursue therapies deemed to be as good as -- or potentially better than -- current standard therapies.
Our patients also benefit from our partnership with the internationally recognized Mallinckrodt Institute of Radiology, an institution with a long and successful research tradition. The Mallinckrodt Institute enables us to offer innovative diagnostic tools and treatment options that are among the best in the nation.
What about research ?
Washington University School of Medicine is world-renowned for advancing medical science through outstanding research. Currently, there is a variety of research underway aimed at
improving our ability to prevent, diagnosis and treat liver cancer and disease. One example is geared toward diagnosing liver cancer metastases earlier and through examination of genetic changes in the blood and bone marrow.
Involvement in national and international medical societies is another advantage of being cared for by a Washington University physician, in which the latest knowledge of the field is brought to your treatment. Cancer patients treated here not only have the opportunity to benefit from our research experience, but contribute to the battle against cancer through participation in clinical trials.
What is I am not from the St Louis area ? Do you have services and places for patients and their families to stay?
We have residential services available. Please click the navigation button at the top of this page for Family and Guest Services.
Patients from outside the United States, please visit International Services.