Innovative Treatment Options Tailored to the Patient
When it comes to metastatic liver cancer and other gastrointestinal conditions,
expert evaluation is vital to
accurately diagnose liver cancer and then determine the best course of treatment for the individual patient.
At Hoag, our
multidisciplinary team of gastrointestinal experts includes liver surgeons, liver transplant surgeons, medical oncologists,
hepatologists and interventional radiologists who work together to thoroughly
review and determine the best treatment option suited to each individual patient.
The Hoag-USC team then carefully tailors a personalized treatment plan
to effectively achieve the best possible outcome for the patient. This
emphasis on a collaborative, comprehensive approach to patient-centered
care is why Hoag patient outcomes rank are among the nation’s best.
The type of treatment recommended depends upon the stage of the cancer
and may include surgery, non-surgical options or a combination of surgical
and non-surgical treatment.
When it comes to metastatic liver cancer, the most effective treatment
option is surgery, often in combination with chemotherapy, since successful
removal of the cancer leads to improved outcomes. Hoag provides the latest
in progressive surgical options including:
- Open Surgical Procedures (right lobectomy, left lobectomy, central resection,
trisegmentectomy and wedge resection)
- Laparoscopic Liver Surgery
- Robotic-Assisted Liver Surgery
When patients are not eligible for surgical removal (resection) of liver
tumors because their cancer is too advanced, Hoag provides a full array
of innovative non-surgical treatment options, including:
- Radiofrequency Ablation
- Arterial Chemotherapy
- Transarterial Chemoembolization (TACE)
- Yttrium-90 Radioembolization
- Radiation Therapy
At Hoag, our expert team of hepatobiliary and pancreatic surgeons performs
the highest volume of liver surgeries in California (more than 1000 liver
resections per year, program-wide), including all forms of liver resection,
such as right lobectomy, left lobectomy, trisegmentectomy and segmentectomy
(wedge resection). And in cases when total hepatectomy is required, Hoag
patients receive streamlined care into the highest volume liver transplant
program in Southern California.
In addition, the Hoag-USC surgical team performs more minimally invasive
liver surgeries than any other surgical program in Southern California.
Being a high-volume liver cancer surgical program enables the gastrointestinal
experts at Hoag to achieve a technical skill level not all facilities
Some of the advanced minimally invasive surgical procedures performed by
the Hoag-USC team include:
Laparoscopic Liver Surgery
Laparoscopic hepatectomy is a minimally invasive procedure in which the
liver is partially resected via several small incisions instead of one
Laparoscopic surgery provides many potential advantages compared to conventional
- Less pain and scarring
- Shorter hospital stay
- Faster recovery, enabling a quicker return to normal activities
During the procedure, a laparoscope (a narrow tube with a camera) is inserted
through one small incision. This allows the surgeon to see the liver via
a high definition monitor. Several thin instruments are inserted through
additional small incisions in order to remove the area of the liver where
the tumor is located, along with a margin of healthy surrounding tissue.
Beyond standard laparoscopic techniques, Hoag-USC surgeons utilize new
technologies to overcome the limitations of traditional laparoscopic surgery.
Innovative technologies such as laparoscopic hand-access devices allow
Hoag-USC surgeons to place their hand into the abdomen during a laparoscopic
surgery and perform many of the precise functions of the hand that were
previously possible only during open surgery.
Robotic-Assisted Liver Surgery
Hoag-USC surgeons continue to lead the way in robotic-assisted surgery
by being one of few centers in Southern California to perform this sophisticated,
minimally invasive surgical approach for treating complex liver cancer.
Being a high-volume gastrointestinal surgery program enables Hoag-USC
liver cancer experts to achieve a technical skill level not all facilities
The new da Vinci®S HDTM Surgical System offers a highly precise, minimally
invasive alternative to traditional surgery, which is why Hoag is pleased
to be a pioneer in this expanded application to liver surgery. However,
robotic-assisted surgery is not appropriate for every patient needing
liver cancer surgery. Since the goal is a successful surgical result,
each patient is evaluated individually to determine if robotic-assisted
surgery is the best option for the individual patient.
Radiofrequency ablation (RFA) is an image-guided technique that heats and
destroys liver cancer cells. During radiofrequency ablation, imaging techniques
such as ultrasound are used to help guide a needle electrode into a cancerous
tumor. High-frequency electrical currents are then passed through the
electrode, creating heat that destroys the abnormal cells. RFA can be
performed percutaneously, laparoscopically or via an open incision.
Although RFA may be performed via open surgical incision, Hoag-USC surgeons,
working in tandem with Hoag interventional radiologists, utilize specialized
techniques for performing RFA using laparoscopic procedures.
It’s important to note that removal of liver cancer by surgical means
is the treatment of choice. Therefore, patients being considered for RFA
should be evaluated by an experienced liver surgeon first, since surgical
removal of the tumor is the best approach for tumor control. However,
for patients who cannot undergo surgery either due to the extent of the
disease, or the presence of cirrhosis or other medical conditions that
pose an excessive risk, RFA is a safe and effective treatment option.
Arterial Chemotherapy (also referred to as Hepatic Artery Infusion) is
designed to improve chemotherapy benefits for liver cancer by increasing
the amount of chemotherapy delivered to the site of the tumor. Chemotherapy
is dispensed from a specialized infusion system in which a catheter is
placed into the hepatic artery to directly deliver the chemotherapy to
the lesion as selectively as possible. This technique spares the normal
liver from the toxic effects of the therapy.
Transarterial Chemoembolization (TACE)
Similar to Arterial Chemotherapy, TACE is a minimally invasive treatment
that delivers chemotherapy directly to the tumor, while also depriving
the tumor of its blood supply by blocking (embolizing) the arteries that
feed the tumor.
Using imaging for guidance, the interventional radiologist inserts a small
catheter into the femoral artery and guides it to reach the blood vessels
supplying the liver tumor. Embolic agents are then injected to keep the
chemotherapy drug in the tumor by blocking the flow to other areas of
the body. This allows for a higher dose of chemotherapy to be used, since
less of the drug is able to circulate to the healthy cells in the body.
Radioembolization is a minimally invasive procedure similar to chemoembolization.
The difference is that Y-90 radioembolization utilizes radioactive microspheres.
It is most commonly recommended in cases where liver cancer cannot be
removed by surgery.
During the procedure, a catheter is inserted through a tiny incision in
the groin and threaded through the arteries until it reaches the hepatic
artery. Once it’s in place, millions of microscopic beads containing
Y-90 are released. The microspheres lodge in the smaller vessels that
directly feed the tumor, stopping blood flow and emitting radiation to
kill the tumor cells while leaving most of the healthy tissue relatively
Radiation therapy is used in selected cases to help control liver metastases
that cannot be surgically removed, or are too large to be treated effectively
Hoag radiation oncologists and medical physicists work together with the
Hoag-USC team of liver cancer experts to develop an individualized treatment
plan using the latest radiation therapy techniques.
Intensity-Modulated Radiation Therapy (IMRT), uses radiation beams of varying intensity that are molded to the shape
of the tumor. Using highly sophisticated computer software and 3-D images
from CT scans, radiation is focused on cancerous tissue with greater precision
than conventional radiation therapy.
Another approach, known as
Stereotactic Body Radiation Therapy (SBRT), uses a highly focused radiation field to deliver greater doses of radiation
in fewer treatments. At Hoag, SBRT is delivered with via a highly advanced
Tomotherapy unit. Tomotherapy is especially suited for SBRT because of
the precise nature of helical IMRT, and the capability to take 3D images
prior to each treatment to verify correct positioning.
Clinical trials play a significant role in gastrointestinal cancer treatment.
That’s why Hoag-USC physicians participate in a variety of clinical
trials in order to bring advanced care to Hoag liver cancer patients.
The Most Advanced Treatment Options Are Now Available in Orange County!
When it comes to seeking out the most advanced, academic-level gastrointestinal
care, there is no longer any need to travel long distances. The
Hoag Digestive Disease Center, in alliance with USC Norris Comprehensive
Cancer Center, offers the latest in state-of-the-art diagnosis and leading-edge treatment
options that may not be readily available at other centers, including
participation in clinical trials that helps to bring advanced gastrointestinal
care to even more patients.
Perhaps the most distinguishing aspect of Hoag’s advanced treatment
of gastrointestinal conditions is that in each and every case, treatment
is always specifically tailored to the meet the unique needs of the individual patient.
Expert Care You Can Trust!
The Hoag Digestive Disease Center, in alliance with USC Norris Comprehensive
Cancer Center, continues to lead the way in complex gastrointestinal care, providing
access to a highly specialized surgical team that works collaboratively
with Hoag-affiliated GI and medical oncology specialists to provide academic-level
care. Hoag’s committed to
accurate diagnosis, combined with
progressive therapeutic options enables Hoag patients to achieve some of the highest clinical outcomes
in the nation.
To schedule a comprehensive diagnostic evaluation, or a second-opinion
consultation with a Hoag gastrointestinal expert, visit
Meet the Team, or call us at: 949-764-5350.