Hepatobiliary Cancer

When one deals with cancer, the hepatobiliary malignancies present a challenge to the oncologist that can be best characterized as a series of unsolved clinical and biological dilemmas. Liver metastases from colorectal and other gastrointestinal malignancies, hepatocellular carcinoma, cholangiocarcinoma and gall bladder cancer present an array of problems but have two features in common; these are high morbidity and mortality with an overall poor result from treatment. Even though there are many reasons to be discouraged in the treatment of hepatobiliary cancer, there are some unique features that the liver presents which allow innovative treatment options. First, the liver is one of the few organs in the body that will regenerate over time. Patients who can be made disease free will usually return to a fully functional state despite the ablation of up to 80% of this organ. Secondly, the liver has an isolated vasculature. Intraarterial infusion, portal venous infusion, and even isolated perfusion are not only possible but have been accomplished and been used in clinical trials. Third, this organ is extremely well characterized radiologically and the progress of treatments can be monitored with great accuracy. Tumor markers assist in this follow-up. Finally, this is an organ that can be transplanted with great success when there is benign disease. If one could control small volume systemic malignancy outside of the liver, transplantation would offer a curative approach in a large majority of patients. The book presents both the credits and debits that one must encounter in dealing with hepatobiliary cancer. The traditional discouragement is blended with opportunity so that the oncologist finds himself wishing to know more and in knowing more to do more in the treatment of hepatobiliary cancer.