When Cancer Spreads to the Liver, Interventional Radiologists Offer Hope

Most of the time, cancer found in the liver originated somewhere else, such as the colon, lungs, or breasts. Once it has spread (metastasized) to the liver, it can be challenging to treat; sometimes the location or number of tumors make surgery impossible, or the patient may be too weak. Until recently, treatment often remained focused on the primary site of the cancer.

These days, doctors and their patients often turn to interventional radiologists for help with metastatic cancer. Using the latest technology and a whole toolbox of minimally invasive techniques, these specialists provide highly targeted treatments for tumors in the liver—and elsewhere in the body—especially when cancer has spread.

"There are very few doctors who specialize in metastatic disease," says Joshua Weintraub, MD, professor of radiology at Columbia University Irving Medical Center and chief of the Division of Interventional Radiology. "You hear about the surgeon who specializes in lung cancer, or the surgeon who specializes in colon cancer. Once the disease has spread beyond those primary sites they often have very little to offer."

Trained in both radiology and minimally invasive procedures, interventional radiologists use real-time imaging to guide catheters and other tiny tools through the veins and arteries to deliver treatment directly to tumors. Their techniques include blocking the tumor's blood supply (embolization), freezing or heating the tumor (ablation), or delivering immunotherapy, chemotherapy, or radiation directly into the tumor in the form of tiny particles.

This kind of local treatment has many advantages, Weintraub explains, the biggest being that treatments are easy to tolerate for most patients. Often, they go home on the day of their procedure with nothing more than a Band-Aid. "Our patients aren't sick, they aren't bedridden, and they're not stuck in the hospital," he says. "We can maintain that quality of life for them and slow the progression of the disease, so they can spend more time with family and friends."

Weintraub and his team treat many types of cancer, with secondary cancer of the liver being the most common. Liver metastases indicate an advanced stage of cancer; tumors are particularly challenging to remove with surgery because of the many blood vessels which pass through or near the liver. Until recently, the outlook for a patient with liver metastases was poor. But with advances in minimally invasive treatments guided by imaging, patients who have access to interventional radiology are experiencing significantly better outcomes.

One of the newer and most effective treatments for cancer in the liver, called Y90 treatment, involves targeting tumors with a radioactive isotope called yttrium 90. A catheter is guided to the tumor under real-time imaging, and the isotope is delivered in the form of tiny radioactive beads, which shrink the tumor as they release radiation. Y90 treatment can be done in an outpatient office and is often used in conjunction with chemotherapy or immunotherapy treatments. In some cases, the treatment can maintain a patient's health while waiting for a liver transplant.

"We think of it as a one-two punch to the tumor," Weintraub says. "Y90 blocks the blood supply to the tumors while delivering a high dose of radiation. It can extend the lives of patients with inoperable tumors and improve their quality of life."

At a big institution like Columbia, interventional radiologists are part of a patient's multidisciplinary treatment team. But patients at smaller treatment centers may not be aware of interventional radiology treatments as they navigate their cancer care. "Most people have never heard of interventional radiology," says Weintraub. "We've historically been a doctor's doctor. When other physicians have unique situations or unusual cases, they're usually the first ones to contact us."

With more medical information available on the internet, he says, patients are increasingly coming directly to his team. Weintraub and his colleagues offer consultations for patients who think they might be candidates for interventional radiology procedures. They coordinate closely with each patient's treatment team.

For patients with metastatic cancer, these treatments can make a big difference in the course of their disease.

"When I started my career, a patient with liver cancer was probably looking at a mean survival of under six months," Weintraub says. "Now, we're doubling or tripling that survival. I have patients living out two, three years with what otherwise would be a deadly disease."