Radiation Therapy for Hepatobiliary Cancers

Hepatobiliary Cancers include malignant or cancerous tumors originating in the cells of the liver, bile ducts, and gallbladder.

The Hepatobiliary System refers to the liver, bile ducts, and gallbladder. These organs are essential for digestion and serve as important processing points for food, medicine, vitamins, minerals, and toxins.

The liver, located on the right side of the abdomen above the stomach, converts the foods we consume into the proteins and carbohydrates that our bodies use for energy. It also stores vitamins and minerals, breaks down toxins, and produces bile.

Diseases that affect the hepatobiliary system, such as cancer, can inhibit the normal functions of digestion, preventing the body from properly absorbing nutrients and processing toxins.

Facts about Hepatobiliary Cancers

Cancer that originally starts in the cells of the liver is known as hepatocellular carcinoma (HCC) or hepatoma. HCC is the fifth most common type of cancer and the third leading cause of cancer-related deaths in the world.

Cancer that originates in bile duct cells is called cholangiocarcinoma. Bile duct cancer is relatively rare, occurring in one to two people per 100,000 per year in the US.

Cases of gallbladder cancer are also rare in the US, with a yearly incidence of about three cases per 100,000 people.

According to the American Cancer Society, the incidence of primary liver and bile duct cancer in the United States for 2013 are as follows:

About 30,640 new cases (22,720 in men and 7,920 in women) will be diagnosed

About 21,670 people (14,890 men and 6,780 women) will die of these cancers

General Risk Factors for Hepatobiliary Cancers

Cirrhosis is a disease that occurs when liver cells are damaged and replaced by scar tissue. Most of the risk factors listed below may lead to cirrhosis, and many people who develop liver cancer suffer from cirrhosis to some degree at the time of diagnosis.

  • Long-term infection with hepatitis B or hepatitis C
  • Heavy alcohol use
  • Obesity
  • Type 2 diabetes
  • Inherited metabolic disease
  • Exposure to toxins such as arsenic, aflatoxins, vinyl chloride, and thorium dioxide
  • Anabolic steroids

Signs of Hepatobiliary Cancers

Many of the symptoms of hepatobiliary cancer are vague and hard to pinpoint, particularly in the earliest stages. Some symptoms that may be present for liver, bile duct, and gallbladder cancers include:

  • Abdominal pain
  • Back pain
  • Abdominal mass
  • Weakness
  • Loss of appetite
  • Weight loss
  • Jaundice
  • Vomiting
  • Changes in frequency of bowel movements

Screening and Diagnosis for Hepatobiliary Cancers

Screening is testing to detect cancer in people with no existing symptoms. For people at higher risk of hepatobiliary cancers, such as those with chronic cirrhosis, doctors may recommend screening every six to 12 months.

Two primary methods are typically used for screening hepatobiliary cancers:

  • Alpha-fetoprotein (AFP) blood test: AFP blood tests are used to detect high levels of a certain protein in the blood that may indicate liver cancer.
  • Ultrasound: Ultrasounds use sound waves and echoes to produce an image of internal organs, which may reveal tumors in the hepatobiliary system.

Diagnosing Hepatobiliary Cancers

Hepatobiliary cancers may be difficult to detect in the early stages. Smaller, early-stage tumors are often missed in physical exams because the liver and associated organs are blocked beneath the rib cage. Diagnostic tools for hepatobiliary cancers may include:

Endoscopic retrograde cholangiopancreatography — ERCP is a procedure used to create images of the digestive tract. During an ERCP procedure, doctors insert a thin, lighted tube into the mouth and down through the stomach to produce an image of the surrounding organs and glands.

Magnetic resonance cholangiopancreatography — MRCP is similar to an MRI, except that is uses specialized software to target the pancreas and bile ducts and create detailed images.

X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.

To confirm a diagnosis, doctors will need to remove a small piece of tissue from a tumor for testing. Often, a biopsy sample can be collected during an ERCP procedure, if one is performed.

Treating Hepatobiliary Cancers

Depending on the location of the tumor, where the cancer originated, the stage of the cancer, and the overall health of the patient, several techniques may be used, either independently or together, to attempt to slow tumor growth or relieve pain.

Treating Liver Cancer:

  • Partial surgical removal of the liver, if all of the tumor can be removed
  • Chemotherapy
  • Radiotherapy
  • Liver transplantation

Treating Bile Duct Cancer

  • Brachytherapy
  • Radiotherapy
  • Chemotherapy
  • Liver transplantation

Treating Gallbladder Cancer

  • Surgical removal of the gallbladder and portions of the liver and lymph nodes
  • Radiotherapy
  • Chemotherapy

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

  • Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth, or to relieve symptoms, such as pain.
  • Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
  • After a diagnosis of liver, bile duct, or gallbladder cancer has been established, it’s important to talk about your treatment options with a radiation oncologist.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the area at risk.

  • Before beginning treatment, you will be scheduled for a simulation to map out the area being treated. This will involve having X-rays and/or a CT scan. You will also receive tiny tattoo marks on your skin to help the therapists precisely position you for daily treatment.
  • Treatment is given once a day, Monday through Friday, for about six weeks.
  • Newer technologies like 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are being evaluated for use in treating hepatobiliary cancers. Ask your radiation oncologist for more information on these treatments.

Possible Side Effects

Common side effects of radiation therapy for patients with pancreatic cancer include loss of appetite, nausea, diarrhea, and fatigue. Side effects tend to accumulate over the course of treatment and subside within weeks or months of the final treatment.