Tampa Bay resident Julie wasn’t shocked when doctors diagnosed her with colon cancer after making several trips to the emergency room due to severe stomach pain. She always thought everyone gets cancer at some point in time, but she wasn’t prepared for the extent of her cancer. Julie’s colon cancer had spread to her liver and ovaries.
Her physician at Moffitt Cancer Center recommended chemotherapy and said she would bring up Julie’s case in the liver tumor board meeting to see if any other physicians could offer any additional treatments. Each cancer program at Moffitt has multidisciplinary tumor boards made up of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, nurses, dietitians, social workers and more. These tumor boards carefully review every new patient so that each one benefits from the expertise of the entire program.
Julie was in luck. Dr. Daniel Anaya, Head of the Section for Hepatobiliary Tumors at Moffitt, working with other members of the hepatobiliary section, including interventional radiologist Dr. Bela Kis, are the first in the world to modify a liver surgery procedure that can cure patients with very complex liver cancer that has spread. The procedure, known as mini-Associating Liver Partition and Portal Vein Ligation, or ALPPS, promotes rapid growth of the liver and makes removal of all cancerous lesions safe and possible.
Surgery, or removal of a portion of the liver with the tumors, is the only treatment that provides a cure for the majority of patients with liver tumors. A huge concern among these patients, however, is that less than 20 percent are eligible to have surgery because removal of multiple lesions often results in very small residual liver, which is not enough to keep the life-sustaining functions of the normal liver. To overcome this major limitation, surgeons have relied on the fact that the liver is the only organ that regenerates and can grow to almost its normal size after surgery. When blocking a branch of the portal vein (a vein taking blood to the liver) by using blocking agents delivered through the skin (portal vein embolization), the liver “believes” it has been cut/removed, inducing growth of the normal side, prior to surgery.
Julie had more than 13 lesions on both sides of her liver. The uniqueness of the modified mini-ALPPS approach used by Moffitt’s Liver Group is that using a combination of different procedures arranged in the appropriate sequence, within two weeks they were able to remove all the cancer found in Julie’s liver (13 lesions) and ovary. Following delivery of chemotherapy, Dr. Kis performed a percutaneous procedure geared at inducing liver growth (portal vein embolization). The next day following this procedure, Dr. Anaya did a small surgery removing the tumors on the left and cutting the liver in a way that would induce faster and bigger growth of the remaining portion of liver. Just one week later, a CAT scan showed dramatic liver growth, and Julie underwent a second surgery to remove the rest of the lesions. Now she is cancer-free.
“The approach and sequence of interventions we used in this case were critical to ultimately allow complete removal of all cancer lesions. The design of this approach and the decision to proceed with it in this case was based on a thoughtful discussion with input by experts from different teams and disciplines,” said Dr. Anaya. “This type of teamwork and cross-collaboration resulted in the ability to remove all the cancer and is what really sets Moffitt apart from other cancer centers across the country.”
Julie began a 12-week chemotherapy regimen in August, and her physicians will determine the next steps based on how well her body responds to treatment.
Julie says she’s grateful to her Moffitt physicians and takes time out now to stop and smell the roses.