The Liver Cancer Program at Smilow Cancer Hospital

CLINICAL TRIALS

Clinical trials are available for patients with advanced or intermediate stage disease, using new

appointments

ablation treatment, new targeted agents, and combinations of treatments to target specific

intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In

close collaboration with basic scientists, clinical research is focused on developing innovative

strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art

genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new

HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the first visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

combinations of therapies and many of our studies are available at our network of Care Centers.

Gary For Gary’s story: m.yale.edu/gary-story

Marissa For Marissa’s story: m.yale.edu/marissa-story

I am delighted with the results and most impressed with the expertise and caring manner of the entire team. Every doctor, every nurse at Smilow is so attentive, so amazing. They do everything they can to make you comfortable and are always there to answer your questions.

– Gary

Gary p: 203-200-5487 | yalecancercenter.org | smilowcancer.org

© 2021 Yale Cancer Center

For Gary’s story: m.yale.edu/gary-story

Liver Cancer Program AT SMILOW CANCER HOSPITAL

CLINICAL TRIALS

Clinical trials are available for patients with advanced or intermediate stage disease, using new

appointments

ablation treatment, new targeted agents, and combinations of treatments to target specific

intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In

close collaboration with basic scientists, clinical research is focused on developing innovative

strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art

genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new

HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the first visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

combinations of therapies and many of our studies are available at our network of Care Centers.

Gary For Gary’s story: m.yale.edu/gary-story

Marissa For Marissa’s story: m.yale.edu/marissa-story

I am delighted with the results and most impressed with the expertise and caring manner of the entire team. Every doctor, every nurse at Smilow is so attentive, so amazing. They do everything they can to make you comfortable and are always there to answer your questions.

– Gary

Gary p: 203-200-5487 | yalecancercenter.org | smilowcancer.org

© 2021 Yale Cancer Center

For Gary’s story: m.yale.edu/gary-story

Liver Cancer Program AT SMILOW CANCER HOSPITAL

CLINICAL TRIALS

Clinical trials are available for patients with advanced or intermediate stage disease, using new

appointments

ablation treatment, new targeted agents, and combinations of treatments to target specific

intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In

close collaboration with basic scientists, clinical research is focused on developing innovative

strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art

genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new

HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the first visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

combinations of therapies and many of our studies are available at our network of Care Centers.

Gary For Gary’s story: m.yale.edu/gary-story

Marissa For Marissa’s story: m.yale.edu/marissa-story

I am delighted with the results and most impressed with the expertise and caring manner of the entire team. Every doctor, every nurse at Smilow is so attentive, so amazing. They do everything they can to make you comfortable and are always there to answer your questions.

– Gary

Gary p: 203-200-5487 | yalecancercenter.org | smilowcancer.org

© 2021 Yale Cancer Center

For Gary’s story: m.yale.edu/gary-story

Liver Cancer Program AT SMILOW CANCER HOSPITAL

T

he Liver Cancer Program at Smilow Cancer Hospital offers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and

intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, when treatment is optimal, and to applying the best treatment options for our patients, as well as to discovering new, more effective treatments.

The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are diagnosed each year in the United States. While the incidence is rising, new surgical, interventional, and medical treatments are being added to our therapeutic armamentarium and are available to our patients. For some patients, these treatments can cure their disease, while for others, liver transplantation may be the solution. After treatment, our team of hepatologists provides continued care to manage the underlying liver disease, preserve liver function, monitor for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply systemic cancer treatment for those in need, as well as access to innovative medications through clinical trials.

HEPATOLOGY

has assembled a dedicated group of specialists, including hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our guiding principle is to personalize and adapt care to the changing needs of the patient.

It was a long journey, full of obstacles and setbacks. I always tell people that I was treated at the best hospital, with the best doctors.

They never gave up on me, and I am so thankful that they kept believing my life was worth saving.

– Marissa

RADIATION ONCOLOGY

personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver

spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at

The Interventional Radiology Program at Smilow Cancer Hospital provides additional treatment options for

a number of risk factors that must be addressed to block the progression of liver disease and to

cancer can in fact benefit from a more liver directed treatment approach. Interventional Radiology provides

Liver cancer is almost always associated with chronic liver diseases of variable severity and with

prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the

function of the liver before and during the treatment. Hepatologists will assess liver function, address risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if

the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After

treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with

surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All

hepatologists working in the Liver Cancer Program are certified transplant hepatologists. If the patient is deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work

definitive or palliative treatment using targeted, minimally invasive procedures performed under precision

image-guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for transplant. These are some of the treatments performed, but the options available are more extensive:

• •

with the patient and the family.

SURGICAL ONCOLOGY AND TRANSPLANT SURGERY

Treatment options for liver cancer can often be complex due to underlying liver function, extent, and location of the tumor, and the overall health of the patient. Surgery often provides the best survival

To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital

INTERVENTIONAL RADIOLOGY

The first team you will meet after being referred to the program will likely be our dedicated hepatologists.

outcomes through resection (removal of the tumor) or liver transplantation and should only be done by skilled and experienced surgeons such as those in our Program. Our surgical teams provide

unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach is tailored to each individual patient. Our teams offer the entire spectrum of surgical care including

complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier.

For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery either because of the location of the tumors or because the liver has too much disease, liver

transplantation can provide definitive cure for both the cancer and the advanced liver disease that

frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor related transplants. Once the patient is actively listed, our transplant hepatology team will provide

comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to control the progression of the tumor during the waiting time in the transplant list.

• • •

Transarterial chemoembolization (TACE): delivers chemotherapy through a catheter directly to the tumor and is the most widely used primary treatment for HCC not amenable to curative treatment by excision or ablation.

Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible or advisable. Ablation can be performed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.

Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has Smilow Cancer Hospital and need radiation oncology can feel confident that they are receiving the

highest quality care from the most experienced team of radiation oncologists in Connecticut. Some of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive

technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in less radiation delivered to surrounding tissue and fewer side effects.

PATHOLOGY

Liver pathologists are an integral part of our team and of the liver tumor board and often help with

difficult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of common and rare liver diseases. Furthermore, the Department of Pathology offers in depth analysis of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments.

IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to induce precision targeted cancer death, while minimizing surrounding tissue damage in the liver.

DIAGNOSTIC RADIOLOGY

Radioembolization (Y90): a minimally invasive procedure that combines embolization and radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor.

diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver

Portal Vein Embolization (PVE): a technique that is performed before a liver resection to increase the size of liver segments that will remain after surgery.

MEDICAL ONCOLOGY

Liver imaging is a major component of our diagnostic armamentarium and requires specialized

technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer scan provides important ancillary information including liver volume, architecture, presence of portal

hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation of iron, etc. For this reason, for all imaging performed at another institution, we require a second

interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For selected cases, contrast-enhanced liver ultrasound is also available.

Our medical oncology team provides experience and knowledge of innovative treatment options and

SUPPORTIVE CARE

there are now several options for targeted biologic therapies (a special type of oncologic therapy that

medical care available and a network of supportive care services. Advanced practice nurses with

treatment that helps the body use its own immune system to find and destroy cancer cells). Clinical trials

throughout the continuum of their illness. Patients and their families are also provided with access

investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however

Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best

targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a

dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients

investigating immunotherapy combinations, and molecular targeted therapies are also available.

to social workers to ensure psychosocial support during their treatment. Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.

T

he Liver Cancer Program at Smilow Cancer Hospital offers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and

intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, when treatment is optimal, and to applying the best treatment options for our patients, as well as to discovering new, more effective treatments.

The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are diagnosed each year in the United States. While the incidence is rising, new surgical, interventional, and medical treatments are being added to our therapeutic armamentarium and are available to our patients. For some patients, these treatments can cure their disease, while for others, liver transplantation may be the solution. After treatment, our team of hepatologists provides continued care to manage the underlying liver disease, preserve liver function, monitor for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply systemic cancer treatment for those in need, as well as access to innovative medications through clinical trials.

HEPATOLOGY

has assembled a dedicated group of specialists, including hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our guiding principle is to personalize and adapt care to the changing needs of the patient.

It was a long journey, full of obstacles and setbacks. I always tell people that I was treated at the best hospital, with the best doctors.

They never gave up on me, and I am so thankful that they kept believing my life was worth saving.

– Marissa

RADIATION ONCOLOGY

personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver

spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at

The Interventional Radiology Program at Smilow Cancer Hospital provides additional treatment options for

a number of risk factors that must be addressed to block the progression of liver disease and to

cancer can in fact benefit from a more liver directed treatment approach. Interventional Radiology provides

Liver cancer is almost always associated with chronic liver diseases of variable severity and with

prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the

function of the liver before and during the treatment. Hepatologists will assess liver function, address risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if

the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After

treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with

surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All

hepatologists working in the Liver Cancer Program are certified transplant hepatologists. If the patient is deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work

definitive or palliative treatment using targeted, minimally invasive procedures performed under precision

image-guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for transplant. These are some of the treatments performed, but the options available are more extensive:

• •

with the patient and the family.

SURGICAL ONCOLOGY AND TRANSPLANT SURGERY

Treatment options for liver cancer can often be complex due to underlying liver function, extent, and location of the tumor, and the overall health of the patient. Surgery often provides the best survival

To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital

INTERVENTIONAL RADIOLOGY

The first team you will meet after being referred to the program will likely be our dedicated hepatologists.

outcomes through resection (removal of the tumor) or liver transplantation and should only be done by skilled and experienced surgeons such as those in our Program. Our surgical teams provide

unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach is tailored to each individual patient. Our teams offer the entire spectrum of surgical care including

complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier.

For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery either because of the location of the tumors or because the liver has too much disease, liver

transplantation can provide definitive cure for both the cancer and the advanced liver disease that

frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor related transplants. Once the patient is actively listed, our transplant hepatology team will provide

comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to control the progression of the tumor during the waiting time in the transplant list.

• • •

Transarterial chemoembolization (TACE): delivers chemotherapy through a catheter directly to the tumor and is the most widely used primary treatment for HCC not amenable to curative treatment by excision or ablation.

Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible or advisable. Ablation can be performed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.

Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has Smilow Cancer Hospital and need radiation oncology can feel confident that they are receiving the

highest quality care from the most experienced team of radiation oncologists in Connecticut. Some of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive

technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in less radiation delivered to surrounding tissue and fewer side effects.

PATHOLOGY

Liver pathologists are an integral part of our team and of the liver tumor board and often help with

difficult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of common and rare liver diseases. Furthermore, the Department of Pathology offers in depth analysis of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments.

IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to induce precision targeted cancer death, while minimizing surrounding tissue damage in the liver.

DIAGNOSTIC RADIOLOGY

Radioembolization (Y90): a minimally invasive procedure that combines embolization and radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor.

diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver

Portal Vein Embolization (PVE): a technique that is performed before a liver resection to increase the size of liver segments that will remain after surgery.

MEDICAL ONCOLOGY

Liver imaging is a major component of our diagnostic armamentarium and requires specialized

technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer scan provides important ancillary information including liver volume, architecture, presence of portal

hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation of iron, etc. For this reason, for all imaging performed at another institution, we require a second

interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For selected cases, contrast-enhanced liver ultrasound is also available.

Our medical oncology team provides experience and knowledge of innovative treatment options and

SUPPORTIVE CARE

there are now several options for targeted biologic therapies (a special type of oncologic therapy that

medical care available and a network of supportive care services. Advanced practice nurses with

treatment that helps the body use its own immune system to find and destroy cancer cells). Clinical trials

throughout the continuum of their illness. Patients and their families are also provided with access

investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however

Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best

targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a

dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients

investigating immunotherapy combinations, and molecular targeted therapies are also available.

to social workers to ensure psychosocial support during their treatment. Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.

T

he Liver Cancer Program at Smilow Cancer Hospital offers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and

intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, when treatment is optimal, and to applying the best treatment options for our patients, as well as to discovering new, more effective treatments.

The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are diagnosed each year in the United States. While the incidence is rising, new surgical, interventional, and medical treatments are being added to our therapeutic armamentarium and are available to our patients. For some patients, these treatments can cure their disease, while for others, liver transplantation may be the solution. After treatment, our team of hepatologists provides continued care to manage the underlying liver disease, preserve liver function, monitor for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply systemic cancer treatment for those in need, as well as access to innovative medications through clinical trials.

HEPATOLOGY

INTERVENTIONAL ONCOLOGY

Liver cancer is almost always associated with chronic liver diseases of variable severity and with

personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver

prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the

or palliative treatment using targeted, minimally invasive procedures performed under precision image-

risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if

transplant. These are some of the treatments performed, but the options available are more extensive:

The first team you will meet after being referred to the program will likely be our dedicated hepatologists.

The Interventional Oncology Program at Smilow Cancer Hospital provides additional treatment options for

a number of risk factors that must be addressed to block the progression of liver disease and to

cancer can in fact benefit from a liver directed treatment approach. Interventional Oncology provides definitive

function of the liver before and during the treatment. Hepatologists will assess liver function, address the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After

treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with

surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All

hepatologists working in the Liver Cancer Program are certified transplant hepatologists. If the patient is deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work with the patient and the family.

Treatment options for liver cancer can often be complex due to underlying liver function, extent, and

has assembled a dedicated group of specialists, including hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our guiding principle is to personalize and adapt care to the changing needs of the patient.

It was a long journey, full of obstacles and setbacks. I always tell people that I was treated at the best hospital, with the best doctors.

They never gave up on me, and I am so thankful that they kept believing my life was worth saving.

– Marissa

outcomes through resection (removal of the tumor) or liver transplantation and should only be done by skilled and experienced surgeons such as those in our Program. Our surgical teams provide

unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach is tailored to each individual patient. Our teams offer the entire spectrum of surgical care including

complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier.

• • • • •

Transarterial chemoembolization (TACE): delivers combined chemotherapy with embolization through a catheter directly to the tumor and is the most widely used primary treatment for HCC not amenable to curative treatment by excision or ablation.

Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible or advisable. Ablation can be performed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.

IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to induce precision targeted cancer death, while minimizing surrounding tissue damage in the liver.

Radioembolization (Y90): a minimally invasive procedure that combines embolization and radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor.

Portal Vein Embolization (PVE): a liver regeneration technique that is performed before a liver resection to increase the size of the segment that will remain after surgery.

MEDICAL ONCOLOGY

For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery

Our medical oncology team provides experience and knowledge of innovative treatment options and

transplantation can provide definitive cure for both the cancer and the advanced liver disease that

there are now several options for targeted biologic therapies (a special type of oncologic therapy that

related transplants. Once the patient is actively listed, our transplant hepatology team will provide

treatment that helps the body use its own immune system to find and destroy cancer cells). Clinical trials

either because of the location of the tumors or because the liver has too much disease, liver

investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however

frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor

targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a

comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to

investigating immunotherapy combinations, and molecular targeted therapies are also available.

control the progression of the tumor during the waiting time in the transplant list.

Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at

Smilow Cancer Hospital and need radiation oncology can feel confident that they are receiving the

highest quality care from the most experienced team of radiation oncologists in Connecticut. Some of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive

technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in less radiation delivered to surrounding tissue and fewer side effects.

SURGICAL ONCOLOGY AND TRANSPLANT SURGERY

location of the tumor, and the overall health of the patient. Surgery often provides the best survival To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital

guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for

RADIATION ONCOLOGY

PATHOLOGY

Liver pathologists are an integral part of our team and of the liver tumor board and often help with

difficult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of common and rare liver diseases. Furthermore, the Department of Pathology offers in depth analysis of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments.

DIAGNOSTIC RADIOLOGY

Liver imaging is a major component of our diagnostic armamentarium and requires specialized

technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver

scan provides important ancillary information including liver volume, architecture, presence of portal

hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation of iron, etc. For this reason, for all imaging performed at another institution, we require a second

interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For selected cases, contrast-enhanced liver ultrasound is also available.

SUPPORTIVE CARE

Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best medical care available and a network of supportive care services. Advanced practice nurses with

dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients throughout the continuum of their illness. Patients and their families are also provided with access

to social workers to ensure psychosocial support during their treatment. Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.

T

he Liver Cancer Program at Smilow Cancer Hospital offers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and

intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, when treatment is optimal, and to applying the best treatment options for our patients, as well as to discovering new, more effective treatments.

The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are diagnosed each year in the United States. While the incidence is rising, new surgical, interventional, and medical treatments are being added to our therapeutic armamentarium and are available to our patients. For some patients, these treatments can cure their disease, while for others, liver transplantation may be the solution. After treatment, our team of hepatologists provides continued care to manage the underlying liver disease, preserve liver function, monitor for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply systemic cancer treatment for those in need, as well as access to innovative medications through clinical trials.

HEPATOLOGY

has assembled a dedicated group of specialists, including hepatologists, hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our guiding principle is to personalize and adapt care to the changing needs of the patient.

It was a long journey, full of obstacles and setbacks. I always tell people that I was treated at the best hospital, with the best doctors.

They never gave up on me, and I am so thankful that they kept believing my life was worth saving.

– Marissa

RADIATION ONCOLOGY

personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver

spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at

The Interventional Radiology Program at Smilow Cancer Hospital provides additional treatment options for

a number of risk factors that must be addressed to block the progression of liver disease and to

cancer can in fact benefit from a more liver directed treatment approach. Interventional Radiology provides

Liver cancer is almost always associated with chronic liver diseases of variable severity and with

prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the

function of the liver before and during the treatment. Hepatologists will assess liver function, address risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if

the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After

treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with

surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All

hepatologists working in the Liver Cancer Program are certified transplant hepatologists. If the patient is deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work

definitive or palliative treatment using targeted, minimally invasive procedures performed under precision

image-guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for transplant. These are some of the treatments performed, but the options available are more extensive:

• •

with the patient and the family.

SURGICAL ONCOLOGY AND TRANSPLANT SURGERY

Treatment options for liver cancer can often be complex due to underlying liver function, extent, and location of the tumor, and the overall health of the patient. Surgery often provides the best survival

To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital

INTERVENTIONAL RADIOLOGY

The first team you will meet after being referred to the program will likely be our dedicated hepatologists.

outcomes through resection (removal of the tumor) or liver transplantation and should only be done by skilled and experienced surgeons such as those in our Program. Our surgical teams provide

unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach is tailored to each individual patient. Our teams offer the entire spectrum of surgical care including

complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional radiologists and hepatologists to optimize liver function before surgery, making surgery safer and recovery easier.

For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery either because of the location of the tumors or because the liver has too much disease, liver

transplantation can provide definitive cure for both the cancer and the advanced liver disease that

frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor related transplants. Once the patient is actively listed, our transplant hepatology team will provide

comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to control the progression of the tumor during the waiting time in the transplant list.

• • •

Transarterial chemoembolization (TACE): delivers chemotherapy through a catheter directly to the tumor and is the most widely used primary treatment for HCC not amenable to curative treatment by excision or ablation.

Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible or advisable. Ablation can be performed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.

Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has Smilow Cancer Hospital and need radiation oncology can feel confident that they are receiving the

highest quality care from the most experienced team of radiation oncologists in Connecticut. Some of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive

technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in less radiation delivered to surrounding tissue and fewer side effects.

PATHOLOGY

Liver pathologists are an integral part of our team and of the liver tumor board and often help with

difficult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of common and rare liver diseases. Furthermore, the Department of Pathology offers in depth analysis of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments.

IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that applies a high voltage of electrical pulses to induce precision targeted cancer death, while minimizing surrounding tissue damage in the liver.

DIAGNOSTIC RADIOLOGY

Radioembolization (Y90): a minimally invasive procedure that combines embolization and radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor.

diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver

Portal Vein Embolization (PVE): a technique that is performed before a liver resection to increase the size of liver segments that will remain after surgery.

MEDICAL ONCOLOGY

Liver imaging is a major component of our diagnostic armamentarium and requires specialized

technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer scan provides important ancillary information including liver volume, architecture, presence of portal

hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation of iron, etc. For this reason, for all imaging performed at another institution, we require a second

interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For selected cases, contrast-enhanced liver ultrasound is also available.

Our medical oncology team provides experience and knowledge of innovative treatment options and

SUPPORTIVE CARE

there are now several options for targeted biologic therapies (a special type of oncologic therapy that

medical care available and a network of supportive care services. Advanced practice nurses with

treatment that helps the body use its own immune system to find and destroy cancer cells). Clinical trials

throughout the continuum of their illness. Patients and their families are also provided with access

investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however

Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best

targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a

dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients

investigating immunotherapy combinations, and molecular targeted therapies are also available.

to social workers to ensure psychosocial support during their treatment. Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.

CLINICAL TRIALS

Clinical trials are available for patients with advanced or intermediate stage disease, using new

appointments

ablation treatment, new targeted agents, and combinations of treatments to target specific

intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In

close collaboration with basic scientists, clinical research is focused on developing innovative

strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art

genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new

HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the first visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

combinations of therapies and many of our studies are available at our network of Care Centers.

Gary For Gary’s story: m.yale.edu/gary-story

Marissa For Marissa’s story: m.yale.edu/marissa-story

I am delighted with the results and most impressed with the expertise and caring manner of the entire team. Every doctor, every nurse at Smilow is so attentive, so amazing. They do everything they can to make you comfortable and are always there to answer your questions.

– Gary

Gary p: 203-200-5487 | yalecancercenter.org | smilowcancer.org

© 2021 Yale Cancer Center

For Gary’s story: m.yale.edu/gary-story

Liver Cancer Program AT SMILOW CANCER HOSPITAL