Interdisciplinary Liver Tumor Clinic

The Interdisciplinary Liver Tumor Clinic at Norris Cotton Cancer Center brings together specialists from disciplines across Dartmouth-Hitchcock Medical Center to offer patients with primary liver cancer the newest, most aggressive treatment regimens, symptom management, and supportive care.

Our goal is to provide the best possible care in the most convenient manner for patients with primary benign or malignant hepatic tumors, as well as advanced and recurrent hepatic malignancy and end-stage liver disease. This clinic is appropriate for patients with any newly diagnosed lesion in the liver whether benign or malignant. The diagnosis of a new liver lesion is often difficult for both the provider and patient. Our interdisciplinary team is here to help.

For more information:

Clinic Services
Patient Profile
Liver Tumor Clinic Team

Clinic Services

Patients receive coordinated consultation, diagnosis, and treatment from a team of specialists in:

Hepatology
Hepatobiliary and transplant surgery
Medical oncology
Radiation oncology
Interventional radiology
Palliative care

Comprehensive diagnostic capabilities, including ultrasound, CT, MRI, angiography, and alpha-fetoprotein blood and liver function tests
Surgical resection and transplant consultation including the use of minimally invasive laparoscopic liver resections and radiofrequency ablation
The latest treatment options in interventional radiology including radiofrequency ablation, transarterial chemoembolization (TACE), and administration of Therasphere treatments
Advanced medical oncology that directs use of local and systemic chemotherapy and radiation therapy including the newest agent, Nexavar, and oral medication that for the first time has convincing evidence of efficacy in hepatocellular carcinoma (HCC)
Interventional gastroenterology including endoscopic ultrasound, ERCP, treatment of esophageal varices, and placement of endobiliary stents for palliation in patients with advanced biliary cancers
Comprehensive palliative care for pain and symptom management, as well as to enhance the physical, emotional, and spiritual well-being of patients and their families
Nutrition support services

Patient Profile

Over the past three decades, the incidence of primary liver cancer (hepatocellular carcinoma and cholangiocarcinoma) in the U.S. has increased significantly. The increase in hepatocellular carcinoma has been driven largely by the hepatitis C epidemic, although the cirrhosis due to other causes including hepatitis B, alcoholism, and fatty liver disease can also predispose patients to the development of hepatocellular carcinoma. Cholangiocarcinoma occurs in the setting of chronic biliary tract disease including primary sclerosing cholangitis and biliary obstruction.

Both hepatocellular carcinoma (HCC) and cholangiocarcinoma are often "silent" in the early stages, and many patients do not exhibit symptoms until their disease is advanced and difficult to treat. The best chance for cure is early diagnosis through screening for HCC in high risk populations, including all patients with cirrhosis and those patients with chronic active viral hepatitis, and periodic reassessment of patients at high risk for cholangiocarcinoma.

Once identified, the best hope for a long term cure is an aggressive approach to treatment. Because primary liver tumors frequently occur in patients with complex co-morbid conditions, an integrated multidisciplinary approach to care is vital. Through the use of new techniques and intensive treatment, patients with primary liver tumors can experience long term survival and may even be cured. The Interdisciplinary Liver Tumor Clinic offers state-of-the-art care for this important and increasing population of patients.