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Normal and cancerous bile cells
Most cancers that arise in the liver and biliary tract are carcinomas, and the different stages at which they present require highly specialized care. Because of the biological and clinical complexity of these malignant lesions, patients with hepatocellular carcinoma (HCC) are most likely to obtain positive outcomes by seeking care at medical institutions with high-volume HCC experience and advanced expertise.
"At Mayo Clinic, we have the diagnostic and treatment breadth, depth, and expertise in the multidisciplinary care of all patients who have benign and malignant tumors," explains Gregory J. Gores, M.D., chair of the Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, Minn. His research focus is hepatobiliary malignancy.
"Often HCC is diagnosed at an advanced stage and/or is complicated by the underlying liver disease; hence, it is often not amenable to curative therapies. Because there are limited options for chemotherapy, comprehensive specialty centers such as ours play a crucial role as innovators in improving long-term outcomes," adds his Mayo colleague, HCC researcher Lewis R. Roberts, M.B., Ch.B., Ph.D.
Mayo Clinic's Hepatobiliary Neoplasia Clinic provides a single site for patients to access coordinated care. From initial evaluation to diagnosis, medical therapy, minimally invasive or open surgery, transplantation, and aftercare, patients benefit from the unified approach of a specialty clinic.
The best patient outcomes are achieved in early-stage HCC through liver transplantation and surgical resection. Local ablative and locoregional therapies can also be effective early-stage options. They include percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization, and transarterial radioembolization.
For nonresectable disease, Mayo Clinic is one of the few centers in the United States to offer novel intra-arterial radiotherapy known as trans-arterial radioembolization. A minimally invasive technique, radioembolization relies on the injection of radioactive (yttrium 90) microspheres into the hepatic arteries that supply the tumor. Once injected, the microspheres selectively implant in tumor arterioles where they emit low-dose radiation targeted to the tumor, which is lethal to the tumor cells. Radioembolization is highly challenging to perform safely and produces best outcomes when performed by experienced teams.
Mayo Clinic physicians have long been pioneers in the diagnosis and management of cholangiocarcinoma. Mayo is now expanding its leadership in the field by improving diagnosis of bile duct cancer with the advanced cytologic technique of fluorescence in situ hybridization (FISH).
Routine cytology analysis relies on visually identifying abnormally shaped cancer cells under a microscope. FISH improves visual detection of malignant cells through the use of fluorescent probes that attach to the DNA of cells and then become brightly visible under a fluorescence microscope. Because cancer cells have an abnormal DNA structure, on FISH analysis, cancer cells show extra copies of the fluorescent probes when compared with normal cells.
In a recent paper published in the journal Gastroenterology, the Mayo research team reported that the combination of cytology and FISH raised the detection rate of bile duct and pancreatic cancer from 20% to 43%.
Beyond advances in diagnosis with FISH, Mayo remains a leader in the treatment of biliary disorders. Among its areas of expertise are the use of endoscopy to relieve jaundice and the development of a new treatment protocol employing liver transplantation for patients with biliary tumors.
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