At the Washington University and Barnes-Jewish Transplant Center, our team has many years of experience treating certain types of liver cancer with a liver transplant.
Patients from across the nation seek us out because of our specialized expertise in treating eligible patients with liver cancer using a protocol to reduce or “downstage” the tumor as much as possible and then performing a liver transplant. Our transplant team works closely with the experts at Siteman Cancer Center to determine the best treatment options for your individual needs.
What is Liver Cancer?
Liver cancer is cancer that begins in the liver, which is different from cancer that starts elsewhere in the body and spreads to the liver. People who have cancer that originates in the liver may be candidates for transplant, depending on their individual condition. Learn more about liver cancer symptoms, risk and prevention.
Patients who have one of two primary types of adult liver cancer may be eligible for transplant:
- Hepatocellular carcinoma (HCC): This is cancer of the liver cells, one of the top five most common cancers in the world. People with cirrhosis, or scarring of the liver, are at particular risk of HCC. As a result of the increased number of people infected with hepatitis C, HCC is becoming more common in the United States. The good news is that when we detect HCC early, we can provide effective treatments.
- Cholangiocarcinoma: This is cancer of the bile ducts – the tubes that drain bile from the liver into the small intestine. Cholangiocarcinoma is an uncommon cancer in the U.S., with only about 2,000 to 3,000 cases diagnosed each year. The early symptoms of this cancer are silent, so it can be hard to diagnose until the cancer is advanced.
Causes of Liver Cancer
The primary causes of HCC include:
- Hepatitis C: This condition presents a 100-fold increased risk of developing HCC.
- Hepatitis B: Chronic hepatitis B infections and suffering from hepatitis B for an extended time cause a high risk for HCC.
- NASH (non-alcoholic steatohepatitis): Also known as fatty liver disease, this is an increasingly frequent cause of liver disease and liver cancer.
- Cirrhosis: Cirrhosis leads to an inability of the liver to function normally, which can cause HCC.
- Alcohol-induced cirrhosis: Having alcohol-induced cirrhosis raises the risk for developing HCC 10-fold.
- Hemochromatosis: This inherited disorder causes the body to absorb and store too much iron, leading to liver damage and a high risk for HCC.
The exact cause of cholangiocarcinoma, or bile duct cancer, is unknown. People with primary sclerosing cholangitis are at higher risk of cholangiocarcinoma.
Liver Transplant as a Treatment for Liver Cancer
In the past, patients with liver cancer had limited treatment options. Today, however, patients suffering from early liver cancer are placed at a higher priority to receive donated livers. Our experience means we treat some tumors that other centers cannot treat with a liver transplant:
- While you are waiting for a transplant, our liver specialists use the latest treatments to shrink the tumor by killing cancer cells.
- If the tumor has not spread to other organs and you do not have cirrhosis, you may be able to have surgery to remove the tumor.
- Shrinking the tumor increases the success rate for the transplant surgery.
If you have liver cancer, the average time on the waiting list to receive a donor’s liver averages 9-12 months. Find out more about the liver transplant process.
Liver Transplant for Hepatocellular Carcinoma (HCC)
Patients with HCC may be a candidate for liver transplant if they have:
- Primary liver cancer that has not spread to other organs in the body
- Stage II (early stage) cancer with a single tumor less than 5 cm in size
- Stage II cancer with up to three tumors, each of which is no larger than 3 cm in size
We often detect liver tumors when they have already grown bigger than the size criteria for transplant. In these situations, we have had excellent success working with our interventional radiology team to reduce the size of the tumors to meet the criteria for a liver transplant. This treatment is also known as downstaging the tumors.
Advanced treatments we perform as alternatives or prior to liver transplantation include:
- Surgery: Liver resection, or surgical removal of the cancer
- Chemo-embolization: Injection of drugs directly into the tumor to kill cancer cells and cut off the blood supply
- Radio-embolization: Injection of radioactive microscopic glass spheres into the tumor
- Radio frequency (RF) ablation: Placing a probe into the tumor and using radio waves to kill cancer cells and shrink the tumor. Find out more about radiofrequency ablation.
Liver Transplant for Cholangiocarcinoma (Bile Duct Cancer)
If your doctor is able to diagnose cholangiocarcinoma before the cancer has spread beyond the liver, liver transplantation may be an option. Once a patient receives a liver transplant, the chance of cancer recurring in the liver is very low.
Our Transplant Center is one of just a handful of centers in the country with established cholangiocarcinoma treatment and transplant guidelines. Since 2005, we have offered sophisticated diagnosis and treatment for patients with bile duct cancer.
Learn more about liver transplant surgery.
For more information about the liver transplant program at the Washington University and Barnes-Jewish Transplant Center, call 855.925.0631.