In the United States, a form of liver cancer known as hepatocellular carcinoma (HCC) is the eighth most common cause of cancer deaths in men. It is one of the few cancers in the country that is becoming more common, due to the increased prevalence of chronic hepatitis C infection. Other significant risk factors include hepatitis B, heavy alcohol consumption, iron overload, and non-alcoholic steatoheaptitis (NASH). Once cirrhosis is present, HCC develops in 1 to 4 percent of patients annually. When it is not caught in the early stages, this cancer has a poor prognosis.

The Liver Tumor Clinic at the University of Washington Medical Center is a unique, comprehensive treatment facility for this disease. “It is a truly multidisciplinary force, and it is more convenient and cohesive than most other cancer clinics” says Dr. Raymond Yeung, a UW professor of surgery who specializes in oncology and hepatobiliary surgery.

Unlike conventional “tumor boards,” in which multiple specialists discuss cases that have accumulated over a period of weeks, UW Medical Center’s Liver Tumor Clinic allows a patient to meet with all of the clinic’s specialists at the same time. “We offer ‘one-stop shopping’ for patients, so they do not have to schedule multiple appointments with different doctors,” Yeung says. “In a single encounter, the patient gets a complete diagnostic workup and treatment recommendation.”

The Clinic is open two days a week. One day it treats patients with primary liver tumors (such as HCC) and the second day it treats patients with secondary tumors, which have metastasized from other organs. It uses state-of-the-art equipment, such as UW Medical Center’s three 64-slice CT scanners, to identify the location and type of cancer and to predict the safety of certain treatments. For example, in volumetric CT analysis, a surgeon can effectively estimate the mass of liver that will remain after a resection. The Clinic also uses minimally-invasive endovascular techniques to determine hepatic ‘blood pressure,’ which is an indication of the severity of scarring in a cirrhotic liver.

There are seven specialties represented: surgical oncology, medical oncology, transplant surgery, hepatology, diagnostic radiology, interventional radiology, and pathology. Just as important as the diversity of specialties is the depth of experience: The Clinic has been running for eight years and sees over 200 new cases a year. “All of our physicians have been treating large volumes of patients for many years, and volume clearly correlates to outcome,” Yeung says. The Clinic’s physicians are also on the cutting edge. As academic doctors, many are active researchers into the causes, prevention, and treatment of cancers of the liver.

Yeung stresses the importance of liver-cancer awareness by community physicians. “Primary care doctors should screen for HCC by ordering regular imaging for their patients with cirrhosis,” he says. “When treated early, these patients can achieve long-term survival.” For patients with metastatic disease of the liver, it is especially important that they be referred to a facility that can offer a range of treatment options. “Some patients receiving systemic chemotherapy for liver tumors may very well benefit from a combined approach with surgery or ablation,” he notes. These multi-modality treatments need to be carefully coordinated among the specialties in order to maximize benefits and safety.

UW Medical Center’s Liver Tumor Clinic has extensive expertise in, and experience with, multiple therapies, including systemic chemotherapy, surgical resection, ablation (chemical, thermal, and cryo), and transplant. The Clinic also offers two techniques, radio-frequency ablation and chemoembolization, which are localized, minimally invasive ways to target a tumor while sparing surrounding tissues. The clinic’s doctors are among the few who perform radio-fequency ablation through small openings in the abdomen (laparoscopic) or the chest (thoracoscopic) for lesions that are difficult or unsafe to treat by other means.

In addition to its excellent physicians, the Liver Tumor Clinic provides an array of experts in social work, nutrition, physical therapy, and patient education. One of ten best hospitals in the country, according to U.S. News and World Report, UW Medical Center houses an experienced nursing staff highly trained in the management and care of patients with liver tumors.

UW Medical Center’s Liver Tumor Clinic is part of the Seattle Cancer Care Alliance (SCCA), a consortium of UW Medicine, Seattle Children’s Hospital, and the Fred Hutchinson Cancer Research Center. For more information about the Clinic, or to make an appointment, call patient care coordinator Jan Thomas at (206) 598-0539 or visit the SCCA web site at www.seattlecca.org.