New techniques for treating liver tumors are allowing patients to recover quickly and experience fewer side effects and complications. In this podcast, members of the multidisciplinary team at UW Medicine's Liver Tumor Clinic will explore the latest in treatment, plus a patient will share his story.
Produced in association with UW Medicine
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If someone is diagnosed with a cancer tumor on their liver, whether it started in their colon or started in the liver, it’s serious business, and coordinated care can make a huge difference. Hear more about it next on Patient Power.
Hello and welcome to Patient Power sponsored by UW Medicine Health System. I’m Andrew Schorr
Well, if someone has more advanced colon cancer, and of course colon cancer is the thing we recommend so often you have regular colonoscopy for, certainly if you’re 50 or older. I do. But if it has spread, it can spread to your liver, so it can metastasize. And there are other people who can develop cancer in their liver itself, and unfortunately that’s been increasing with the incidence of hepatitis C, which is an epidemic actually in the United States. In either case, it calls for specialized care.
And at the Seattle Cancer Care Alliance they have that, where they have the various specialists who have approaches that can come together to treat that, all working together for the benefit of the patient. We’re going to talk about that as an example of coordinated care for liver cancer or metastatic cancer that’s spread to the liver as--as it can make such a difference for people.
And one person who has been affected in a very positive way by that is Derek Epps, who is 39 years old. He’s an attorney and he lives in McCleary, Washington, which is west of the capital in Olympia, and Derek is recovering now from robotic surgery that he had. He’s working, and he’s been working throughout, but he has had various procedures.
Derek, it all started several months ago when they thought you had an inflamed appendix, right?
That’s correct. I was diagnosed with appendicitis in February of 2011.
And so they take out your appendix, but they still think something is not right. You have further diagnostic tests, and they then do a colonoscopy. Something is not right, and based on that they referred you for specialized care at the University of Washington and Seattle Cancer Care Alliance, right. They wanted--and you wanted that second opinion.
That’s correct. I wanted a second opinion. I had been diagnosed with a mass in my colon, but it wasn’t positively identified as cancer at the time.
Well, it certainly is a scary event no matter what not--not knowing what’s going on. So you had another colonoscopy and other exams, and what did they say it was?
At that stage they thought it looked like cancer although they didn’t do any more biopsies on the--on the tumor itself, on the mass, but recommended me for surgery with Dr. Sinanan.
At the University of Washington. So you had surgery, and how much of your colon and digestive track was removed?
They took out about a foot of my colon and ilium including the ileocecal valve.
Wow. Wow. Long way from having just an appendicitis. So there was a concern, I understand, that there had been a spread to your liver.
Yes, there was.
And so that connects you with one of our other guests today, and that is Dr. Veena Shankaran. She’s a medical oncologist. She’s an assistant professor of medical oncology at the University of Washington School of Medicine. She’s a specialist in this area of gastrointestinal cancer.
So, Dr. Shankaran, when you did all the exams what did you believe had happened with the liver? Was it as I described earlier, that cancer from the colon can spread and in this case had?
Yeah, when--you know, when I first met Derek it was after his two surgeries on the colon, so first the appendix surgery and then the subsequent colon surgery, and around that time we had attained a CT scan to do staging basically to look for any evidence of spread outside the colon. And the liver is one of the most common sites for colon cancer to spread, and there was a single spot that was noted on that CAT scan that was suspicious for colon cancer spread to the liver.
So--and I know I kind of lived this years ago. This happened exactly to my mother, although I think it had spread more than that. So different modalities can come together, so would an approach here be part chemotherapy or drug therapy and if possible some approach, some surgical approach?
Yes, it’s a little bit of an obviously complex situation because there are many treatments that you can use, and sequencing those treatments obviously require some discussion. But essentially when I met Derek, we knew he had a stage III colon cancer at the least and then soon found out later he was a stage IV with this liver lesion. And certainly many studies have shown that chemotherapy is indicated in controlling disease and preventing spread of disease, so we immediately initiated that.
But there was concern that this liver lesion needed to be addressed, and it was preferable for us to address this sooner rather than later so that’s when we got the liver clinic involved, and Derek saw them shortly after he initiated chemotherapy to discuss this.
We’re going to talk about the liver tumor clinic and its unique capabilities in just a minute, but I want to bring the surgeon involved. And so this is Dr. James Park, surgical oncologist. He’s an assistant professor and he’s in the hepatobiliary area of surgical oncology at the University of Washington and Seattle Cancer Care Alliance.
So, Dr. Park, I understand in Derek’s case your approach that you all discussed with him was to do a robotic surgery, so sort of minimally invasive, to try to take out as you call that lesion. So talk about that for a minute, what you’re able to do in a minimally invasive way now. And I find it so incredible when I think about the liver, a lot of people don’t realize it, is that you can take part of the liver out and the liver can grow.
That’s right. So, actually, Derek’s case was discussed in a different conference in a multidisciplinary pancreas cancer clinic that we have at the SCCA, and Veena and I just happened to be there at the same time, and she pulled me aside and consulted me about the possibility of going ahead with chemotherapy versus performing surgery to the liver first. And we looked at his scan together, and the lesion or the tumor in question was in a very favorable location for Derek to undergo minimally invasive robotic-assisted surgery, and that would give us an opportunity to get him recovered quickly to get back to Dr. Shankaran to get more chemotherapy for the both the adjuvant therapy for the colon primary but also adjuvant therapy for the liver metastasis.
So you’re absolutely correct. The liver is unique, with the exception of the central nervous system. It has a remarkable ability to regenerate, and in a case such as Derek’s where he had taken good care of his liver, one can remove up to 75, 80 percent of the liver and the remainder would grow back. Certainly, his case, the tumor was quite small, it measured about 2 centimeters, and it was peripherally located, so we were capitalizing on that favorable location to try to provide him with a minimally invasive approach.
Normally this operation would have required an incision that’s about maybe three or four inches in size. It would require a three-to-four week recovery before he would be able to get back to a medical oncologist such as Dr. Shankaran to get chemotherapy, but he really outpaced everyone and has done remarkably well.
And, Derek, you told me that you had been working throughout this whole procedure, right? I mean, you had the robotic approach. You’ve been working as an attorney. I understand you work for a shellfish company as an in-house counsel, so it’s like a company that has farms for geoducks and other shellfish, interesting work. But you’ve been able to do that through much of this, right?
Oh, absolutely. With the liver surgery I was probably--it affected me the least of any of the three to some degree. I was up and walking around and doing--trying to do physical activity within 24 hours of the surgery.
But as well, I had my laptop computer with me so--I work from home a lot too at times, and working from the hospital room wasn’t that much different. It just had a little more comfortable bed with some better options.
By Eliot Finkelstein