Surgical Oncology and Colorectal Surgery

Hepatobiliary

Doctors look over a chart and smile

This is cancer which involves the Liver or the ducts that drain bile from the liver to the intestines, bile duct cancer. Gallbladder cancer is a rare form of cancer which affects the gallbladder and is included in the group of cancers. The mainstay of treatment for these types of tumors is surgical resection of the cancer. Often this involves removing part of the liver or the ducts draining the liver. Unfortunately often surgery is not possible and in that case we offer many other treatment options in collaboration with our medical and radiation oncology colleagues. Some of these treatments include

Radiofrequency Ablation of cancer by using microwaves to actually kill the cancer, sparing the surrounding normal liver. This type of ablative surgery is often performed with the guidance of intraoperative ultrasound. An ultrasound uses sound waves to better identify the tumor and allow for better placement of the ablation device in the center of the tumor.

Chemoembolization is the direct injection of chemotherapy into the arteries which supply the cancer, often resulting in the cancer shrinking and possibly allowing surgical resection

Radioactive bead embolization is the injection of very small radioactive beads into the liver causing the radiation to actually shrink the cancer.

Chemotherapy may also be an option for certain types of liver and bile duct cancers and our medical oncologists have outstanding experience dealing with these types of tumors.

The treatment of these types of cancers often involves a “team” approach which is available in a comprehensive approach at the Peyton Anderson Cancer Center.

The Hepatobiliary System

The hepatobiliary system plays a vital role in the body's digestion. The liver, pancreas, gallbladder, and bile ducts make up the hepatobiliary system. The organs that make up the hepatobiliary system are susceptible to a broad range of diseases and medical conditions.

Hepatobiliary diseases are part of a heterogeneous class of diseases of the liver and biliary system, which are the cause of viral, bacterial, and parasitic infections. Other causes of hepatobiliary diseases include:

  • Toxic chemicals
  • Cardiac failure
  • Neoplasia
  • Alcohol consumption
  • Cirrhosis
  • Metabolic disorders
  • Poor nutrition

In the United States, two common diseases of the liver include viral hepatitis and cirrhosis. The primary chronic disease of the biliary system is cholelithiasis. Viral hepatitis, hemochromatosis, obstructive lesions in the biliary system, and alcoholism are common causes of cirrhosis.

The Liver

The liver is one of the body's largest organs. There are many functions the liver is responsible for, which include:

  • Processing food and converting it to energy
  • The breakdown of toxic substances
  • Storing vitamins, minerals, and iron
  • Making bile that helps with digestion

There are many diseases and disorders that can influence the liver, which include:

Liver Tumors

Liver tumors can be cancerous and grow in many places in or around the liver. Some common liver tumors, which are cancerous, include:

  • Hepatocellular carcinoma
  • Colorectal cancer
  • Neuroendocrine cancer
  • Metastatic tumor

Benign Liver Tumors

Although benign liver tumors are not cancerous, it is imperative they are treated if there are symptoms present that demonstrate the tumors are precancerous. Some benign liver lesions are known as:

  • Adenoma
  • Focal Nodular Hyperplasia
  • Hemangioma
  • Hepatic cyst

Pancreas

The pancreas is an organ that lies between the stomach and the spine. The pancreas is responsible for the production of fluids to break down food and to make hormones that regulate blood sugar levels.

Some medical conditions that affect the pancreas are:

  • Pancreatic cancer
  • Acute pancreatitis
  • Chronic pancreatitis
  • Pseudocyst

Gallbladder and Bile Ducts

Bile is important because it helps the body digest fats. When bile is produced in the liver, it is sent to bile ducts and then stored in the gallbladder.

Here are medical conditions that can impact the gallbladder and bile ducts:

  • Gallstones
  • Bile leakage
  • Gallbladder cancer
  • Bile duct cancer
  • Caroli disease
  • Stricture

Treatment Options for Hepatobiliary Conditions

There are several ways to treat conditions of the hepatobiliary system, which include the following:

Surgical Procedures

Cholecystectomy

Although this procedure is not advised for individuals with asymptomatic gallstones, it is recommended for those with other conditions such as a porcelain gallbladder or if gallstones are found during an abdominal surgery. In most cases, laparoscopic cholecystectomy is performed with a gallstone clearance rate of close to 100%.

Ampullectomy

This surgical procedure is for patients who have a tumor that obstructs the ampulla. This type of surgery is performed through endoscopic or surgical techniques. For small lesions that do not appear to be cancerous, endoscopic snare excision is performed.

Medication

Gallstone Dissolution Medication

Ursodeoxycholic acid is a bile acid that is used for dissolving gallstones, microlithiasis, and biliary cirrhosis. Patients with Caroli disease may also benefit from gallstone dissolution agents.

Farnesoid X Receptor

The liver, intestines, kidneys and adipose tissue expresses farnesoid x receptors, which is a nuclear receptor. The receptor works to regulate genes that are involved in controlling bile acid synthesis.