Baylor Scott & White Health delivers multidisciplinary care to combat rise in liver cancer

In Texas, a disproportionate number of people have non-alcoholic fatty liver disease, non-alcoholic steatohepatitis (NASH) and NASH cirrhosis. Combine these conditions with alcohol misuse, and you have a state with the highest rate of liver cancer in the nation.

To combat the rise in this deadly condition, Baylor University Medical Center at Dallas (Baylor Dallas), part of Baylor Scott & White Health, and Baylor Scott & White All Saints Medical Center – Fort Worth (Baylor Scott & White Fort Worth) take a multidisciplinary, 360-degree approach to treating patients, including liver transplant for patients, with primary hepatocellular carcinoma (HCC).

Specialists in hepatology, interventional radiology, radiology, oncology and surgery all participate in creating a care plan for each patient seen in clinic. For patients without cirrhosis or patients with cirrhosis who do not have portal hypertension, surgical resection may be possible. Other treatment options include ablation, chemoembolization, radioembolization, radiosurgery and liver transplant.

“Liver transplant is one of the few curative options for patients with primary liver cancer,” says Ranjeeta Bahirwani, MD, a hepatologist on the medical staff at Baylor Dallas. “But by the time many patients are diagnosed, their tumors are too advanced to be amenable to transplant. We are increasing our screening of patients with liver disease to identify cancers earlier and get patients linked to care.”

A patient with HCC may be eligible for a liver transplant if he or she has a single lesion no larger than 5 centimeters or three lesions each smaller than 3 centimeters. In addition, there can be no evidence of metastatic lesions.

“If a patient’s tumor is outside the strict transplant criteria, we can often downstage the tumor with a combination of liver-directed therapies or systemic therapies, such as targeted therapies or immunotherapy, permitting these patients to become candidates for transplantation” says Hoylan Fernandez, MD, chief of hepatobiliary surgery at Baylor Scott & White Fort Worth. “Because these patients often have low native MELD scores, which makes them less competitive for a transplant until they obtain their HCC point upgrade, we encourage these patients to find a living liver donor.  With living donation, they are able to achieve transplant quickly, preventing these patients from disqualification from transplant if their cancer continues to grow or becomes metastatic as they wait for a cadaveric donor.”

As with other cancers, the key to successfully treating HCC is regular surveillance and early detection. In addition to clinics based at Baylor Dallas, Baylor Scott & White Fort Worth, Baylor Scott & White Medical Center – Plano and Baylor Scott & White Medical Center – Round Rock, 10 outreach clinics are located in smaller cities throughout Texas. The goal of this outreach program is to reach patients in regions that have access to fewer specialists and resources than large metro areas. Hepatologists on the medical staff at Baylor Dallas and Baylor Scott & White Fort Worth travel regularly to these clinics to see patients and provide ongoing care.

“Our goal is to establish these patients under the care of a hepatologist where they live,” Dr. Fernandez says. “Patients with advanced liver fibrosis or cirrhosis have an ultrasound or MRI every six months as surveillance. We want this to be as routine as any other health maintenance cancer screening. By going to where the patients are, we can detect and treat their liver cancer much earlier.”

For especially challenging cases, a multidisciplinary liver tumor board conference is held. Numerous physicians from Baylor Dallas and Baylor Scott & White Fort Worth review cases and, as a group, decide how to proceed with the treatment.