Breast, bowel, or stomach cancers are tumor diseases that many people have heard of. It is less well known that malignant tumors also not uncommonly arise in the liver. These usually occur in one of two variations: in the form of liver metastases, in other words, groups of tumor cells from other tissues which arrive in the liver and begin growing there. Alternatively, the cancer can develop directly from the liver cells. In this case, the tumor is called hepatocellular carcinoma (HCC). It is the fifth most common malignant tumor worldwide and the third most frequent cause of cancer-related death. In most cases, HCC develops from chronic liver disease that has resulted in liver cirrhosis. Liver cirrhosis is caused by viral infections of the liver in particular and also by metabolic disorders, chronic fatty liver, and excessive alcohol consumption. 

Tumors can also develop in the bile ducts (the “biliary system”). These are referred to as cholangiocarcinomas. There are both large bile ducts located outside the liver (including the gallbladder) and smaller bile ducts located within the liver from which tumors can arise. Hepatocellular carcinomas (HCC), cholangiocarcinomas, and gallbladder carcinomas belong to the group of hepatobiliary tumors.

The Liver Cancer Center Heidelberg (LCCH), located at NCT Heidelberg, was established in 2012 with the goal of responding to the demands of the increasing medical significance of hepatobiliary tumors in terms of research and treatment. At the LCCH, numerous specialists from the fields of surgery, oncology, gastroenterology, pathology, diagnostic and interventional radiology, nuclear medicine, and radiation oncology work together in an interdisciplinary manner at promptly translating the latest scientific findings into clinical studies in order to improve the possibilities for treating hepatobiliary tumors. Representatives from all disciplines discuss up to 20 cases twice a week in interdisciplinary tumor board meetings. A patient database and molecular diagnostic software aid in quickly and effectively identifying those patients likely to profit from new clinical trials.

Examination methods/diagnostics

Hepatobiliary tumors are generally late to cause symptoms, which include tenderness on palpation of the right upper abdomen or progessive jaundice. Frequently, HCC is an incidental finding during a routine screening examination in patients with chronic liver disease or liver cirrhosis. Suitable diagnostic procedures include imaging (sonography, MRI, CT) and endoscopy. Powerful, high-performance equipment for examining the liver and biliary system is available at Heidelberg University Hospital. If a tissue sample is taken for further diagnostic work-up of a liver lesion, one of the leading European liver pathology centers that examines more than 4,000 cases per year is available in Heidelberg for the immunochemical and molecular characterization of liver tissue.

Therapeutic procedures

Therapeutic curative options for patients with early stage HCC consist of resection or liver transplantation. For patients in an advanced stage of disease, the Department of Diagnostic and Interventional Radiology offers innovative local or regional therapeutic procedures such as transarterial chemoembolization with chemotherapeutic drug-loaded particles. In Heidelberg, a study is presently being conducted in which HCC lesions are irradiated with heavy ions. If no local or regional procedures can be applied, the hepatologic and oncologic expertise at the LCCH for therapy is paramount. Several clinical studies with innovative targeted therapies are offered to the patients at NCT Heidelberg.

Aftercare

The LCCH team is also available to provide aftercare following surgical removal of hepatobiliary tumors. This includes laboratory tests and ultrasound, as well as endoscopy and CT or MRI. Time intervals for follow-up examinations depend on the previous tumor location and extent and are determined individually.