Treatment of Metastatic Islet cell Tumors
What is liver metastasis?
Liver metastasis is spread of the cancer to the liver. Many different types of cancers spread to the liver such as all gastrointestinal cancers, breast and lung cancers and islet cell tumors of the pancreas.
Is liver metastasis treatable by surgery? Is chemotherapy the only treatment for this since the tumor has spread to the liver?Removal of the cancer by surgery is an treatment option for some patients with liver metastasis. We would offer liver surgery for liver metastasis for the following :
Do islet cell tumors metastasize to the liver?
Islet cell tumors of the pancreas commonly metastasize (spread) to the liver. Metastasis may be present in as many as 50% of all patients at the time. Unlike liver metastases from other tumors that rapidly lead to liver failure and death, liver metastases from islet cell tumors are slow growing and the patient may live for many months to years after the diagnosis.
Is liver metastasis from islet cell tumors treatable by surgery?
All liver metastases from islet cell tumors should be evaluated for possible surgical removal of the tumor. If the tumor is confined to one or the other lobe of the liver then liver resection (liver removal) is indicated. Partial removal of the liver is an extremely safe operation today and the death rate from this procedure is less than 2% in major surgical centers that frequently perform this type of surgery.
Removal of the liver cancer is an option for patients in whom the tumors are mainly localized to one lobe either the right or the left side of the liver since this allows the surgeon to remove the affected side of the liver and the remaining side will be sufficient to provide liver function that is necessary for survival to the patient after surgery. Surgery is usually not an option when the cancer has widely spread to both side of the liver.
What type of liver surgery is offered for islet cell tumors that have spread to the liver?
The following types of liver resections are offered at USC for islet cell tumors that have spread to liver:
What other treatments are available for liver metastases from islet cell tumors treatable by surgery? Islet cell tumors in the liver that are not removable by surgery?
Removal of the liver tumors by liver resection is a treatment of choice for patients who have tumors spread to their liver. In patients in whom this is not possible because the tumor is found to have spread into both the right and left side of the liver the following treatment options may be available:
Radiofrequency ablation (RFA): In this is procedure the liver is subjected to intense heat to destroy the liver cancer. An alternating electric currant is passed through the tumor tissue, generating heat at the site of the tumor that destroys the tumor. Specialized RFA devices are available to deliver the heat into the tumor for tumor destruction. RFA is an option in patients who have disease in both lobes of the liver and therefore surgical removal of all of the disease is not possible.
In selected patients we have developed an aggressive approach that utilizes both RFA and surgical removal of the tumor. In this approach the part of the liver that is most affected by tumor spread is removed by surgery. The remaining liver tumors are treated with radiofrequency ablation. Patients are followed after the surgery and if there is tumor recurrence in the liver then this may be treated by further surgical removal and/or radio frequency ablation.
Hepatic artery chemoembolisation: Islets cell tumors commonly metastasize to the liver and the blood supply to these tumors comes from the hepatic artery. These tumors usually have a very rich blood supply and therefore injection of chemotherapy agents bound to substances that block the arterial blood supply to the tumor can provide an opportunity for high concentration of chemotherapy directly to the tumor.
At USC we utilize a special technique in which the chemotherapy is bound to collagen particles that are then injected selectively into the artery supplying the blood supply to the tumor. This treatment is offered to patients who are not candidates for surgical removal of their tumor.
Hepatic artery chemoembolisation may also provide relief from symptoms in patients debilitated by symptoms of hormonal over secretion. Furthermore in some patients’ dramatic tumor responses can be seen. Appropriate selection of patients for this treatment is important
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