The hepatobiliary system includes the liver, gallbladder, bile ducts, and the pancreas. Upper abdominal pain, a sense of bloating, weight loss, and occasionally jaundice are the presenting symptoms of tumors in these locations.

The Rivers Cancer Center surgeons work closely with the physicians at the Virginia Piper Cancer Institute (VPCI), (including Dr. Sielaff, who heads the service line), to diagnosis, stage, and treat patients with hepatobiliary malignancies.

Overview of Hepatobiliary Cancers

Liver Cancer
There are several types of liver cancer, both primary and metastatic. About 80-90% of primary tumors are hepatocellular carcinomas. The cause of most of these tumors is cirrhosis (chronic scarring) of the liver, that develops from alcohol abuse, hepatitis B or C, a variety of autoimmune diseases, or from iron overload. Since immunization against the hepatitis B virus is available, many cases are potentially preventable, and River Falls Medical Clinic family physicians encourage vaccination for all patients.

Pancreatic Cancer
The pancreas makes digestive enzymes and hormones such as insulin. Tumors in the pancreas are classified as exocrine (99% of cancers) or endocrine (1% islet cell tumors). Almost all (95%) of pancreatic exocrine tumors are classified as adenocarcinomas. After evaluation of these patients, about 20% are found to have disease limited to the pancreas and are candidates for surgery (Whipple procedure).

Although outcomes are improving and surgery has become safer, the 5-year survival rate from the disease remains dismal. VPCI is a member of the Pancreatic Cancer Research Team ( www.pcrt.org ), a group dedicated to rapidly advancing the field of pancreatic cancer care through basic research and new drug investigation. Over 80% of surgical patients are participating in clinical studies and we offer some of the most promising new agents for clinical evaluation. The ras protooncogene is mutated and activated in 95% of pancreatic cancers, and there is hope that therapeutics that target ras will soon improve survival of patients with pancreatic cancer.

Metastatic Cancer
The liver is a frequent site of metastasis for many cancers. Occasionally, the liver is the only site of spread, and the metastasis can be surgically removed or treated with radio frequency ablation or cryoablation (freezing). This is not an unusual situation in colorectal cancer. Patients with liver metastasis are typically evaluated with CT, MRI or PET scanning. If no other anatomic site of cancer spread is evident, patients are referred for evaluation and treatment.

Since many cancers in this region of the body are notoriously difficult to treat, patients are encouraged to enroll in clinical trials or innovative treatment protocols. Many services, including medical oncology consultation and chemotherapy can be delivered locally.

Referral appointments to Virginia Piper Cancer Institute surgeons or gastroenterologists can be scheduled and coordinated through the Rivers Cancer Center.