What is liver disease? What is pancreatic cancer? What are liver tumors

How do I get treatment?

For further information and appointments please see the below contact numbers:

For Mr Rob Hutchins:

020 7234 2940

For the following Consultants:

020 7234 2730

Professor Nigel Heaton
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Michael Heneghan

Biliary Cancer treatment London

Treatment Options for Biliary Cancer in London Bridge Hospital

The treatment options for cholangiocarcinoma are determined by stage of the disease in terms of tumour size and extent, involvement of the major blood vessels flowing into the liver, and the presence or absence of metastases.

Adjuvant therapy

Adjuvant chemotherapy (i.e. chemotherapy given after an operation, with the intent of mopping any remaining cancer cells in the system) has been tried. Many drugs have been used but none have been shown to improve survival unequivocally. A variety of trials are ongoing to explore the usefulness of adjuvant therapy and to determine which drugs have benefit in unresectable patients. Radiotherapy is rarely used for this condition in the UK.

Photodynamic therapy

Photodynamic therapy (PDT) involves the intravenous administration of a photosensitiser. This localises preferentially in tumour tissue over the next 24-48 hours. After that an endoscope is passed into the gut, and a laser light is shone upon the tumour. This activates the photosensitiser, generating oxygen free radicals and causing cancer cell death. There is some evidence that biliary stenting combined with PDT (versus stenting alone) leads to increased survival, improved physical status, better bile flow and better quality of life. This treatment modality could offer useful palliation and further studies of PDT in combination with chemotherapy or radiotherapy or both are required.

Surgical resection

Complete surgical removal of the tumour with clear margins offers the only possible cure for cholangiocarcinoma and gallbladder cancer. Unfortunately many patients present with unresectable disease at diagnosis. The few patients considered suitable for surgery must be medically fit, with no metastases and have local disease that can be resected with clear margins.

Patients with poor physical health, major cardiovascular disease or advanced liver cirrhosis are not candidates for surgery. The presence of infection, severe jaundice and malnutrition also predict poor outcomes but may be corrected to an extent prior to surgery.

Draining the blocked biliary system (by ERCP or PTC) prior to surgery has not been shown to significantly decrease morbidity or mortality. But it should be considered in all patients with severe jaundice (who run the risk of liver failure) and in those with biliary infection (cholangitis). If it is felt that the proposed operation will remove over 75% of the liver, and not leave the patient with a sufficient remnant liver, then selective portal vein embolisation (PVE) can be done.

The type and extent of surgery depends on the location of the cancer within the liver or the biliary tract.
In most Western hospitals around 15-35% of cholangiocarcinomas prove resectable, though adoption of a more aggressive policy in terms of en-bloc resection with vascular reconstruction (i.e. resecting and repairing major blood vessels involved by the tumour) can lead to more resections. The adoption of an aggressive resection policy correlates with a significant trend towards prolonged survival, with 40-60% 3-year survival rates in most series. However, the more extensive resections are associated with a higher mortalility of around 10% and significant postoperative morbidity up to 40%.

Surgical palliation

A surgical biliary-enteric bypass, i.e. creation of a join between the biliary system (above the level of the blockage) and the bowel, can be performed to relieve jaundice, even if the tumour itself cannot be resected. This is particularly relevant for patients who undergo an operation but are then found at the time of the operation to have unresectable disease. Coeliac plexus blockade can be considered for severe pain.

Surgery

If a surgeon suspects gall bladder carcinoma at the time of a laparoscopic or open cholecystectomy for stone disease, it is reasonable to take tissue samples for histopathology and then end the operation, with the intention of subsequently referring the patient to a specialist centre.

If an expert biliary surgeon is at hand, it may be reasonable to proceed immediately to a major operation, with confirmation of cancer on frozen section (this is a rapid analysis of a tissue sample) as the first step. But the surgeon will then have to very carefully evaluate the extent of disease (without the benefit of CT or MR scans) and determine if it is appropriate to proceed to a major operation that the patient has not been prepared for.

If gall bladder cancer is described in the pathologist’s report after a routine cholecystectomy, the two important questions are: how deeply had the tumour invaded through the gallbladder wall, and did it reach up to the surgical margins? For some tumours, a second, more radical operation should be performed. This may involve a resection of the part of the liver that adjoins the gall bladder (called an extended cholecystectomy) or even a formal excision of liver segments 4b and 5, with removal of the regional lymph nodes, and excision of the extra-hepatic bile duct. The laparoscopic port sites (the entry points of the instruments) may also be excised.

Following surgical resection with clear margins, 5-year survivals of 62-100% have been reported in patients with T2 lesions, and 20-50% in patients with more advanced lesions.