Hepato-Bilio-Pancreatic Tumours
Outline
Hepato-bilio-pancreatic tumours comprise tumours of the liver, biliary ducts and the pancreas. Ranked by order of frequency, after cancer of the colon and of the stomach, cancers of the pancreas are in third place on the list of digestive system cancers. The number of new cases annually in Europe is 80,000.
Cancers of the liver are especially common in China, Japan, and in Africa. In Europe, their rate is low, yet it has doubled in 25 years, mainly due to the epidemic of hepatitis C. As for tumours of the biliary ducts, these are rarer still, yet their frequency is also increasing at the same rate.
Just over two hundred hepato-bilio-pancreatic tumours were treated in 2007 at the Saint-Luc University Cancer Centre Clinics, and this number is constantly increasing. They are distributed into:
- tumours of the pancreas: 40 % new cases
- tumours of the liver: 50% of cases, of which hepatic metastases, which stem most often from cancer of the colon, but also from other locations (breast, endocrine tumours…) constitute 30% and basic tumours 20%.
- tumours of the extrahepatic biliary ducts: 5 %
- endocrine tumours: 5% of cases. These tumours stem from the cells of the pancreas which secrete hormones (insulin, gastrin…).
Treatment of these tumours requires a pluridisciplinary approach in which surgeons, medical oncologists, gastro-enterologists, radiologists, nuclear physicians, radiotherapists, anatomical-pathologists, take part. This pluridisciplinary group meets every week, sharing knowledge is indispensable to provide each patient with a treatment which corresponds best to their illness.
Symptoms
Pancreatic and biliary tumours are generally characterised by pain in the upper part of the abdomen, loss of weight and a yellow complexion. Primary tumours of the liver are often discovered by chance, for example during an echography carried out on a patient suffering from cirrhosis.
Symptoms of endocrine tumours vary according to the hormones produced by the tumour.
Risk Factors
Cancer of the pancreas can be hereditary. It can also come about from chronic inflammation of the pancreas, caused by alcohol and tobacco.
Primary liver cancers are followed by cirrhosis in 80% of cases, cirrhosis is caused by the hepatitis B or C virus, or by alcohol, whereas not much is known about the risk factors for biliary tumours and endocrine tumours.
Diagnosis
In addition to traditional radiological examinations, two specific techniques are particularly useful in diagnosing this type of tumour: echo-endoscopy and octreoscan.
Echoendoscopy is an examination which combines an endoscopy and an echography. An echography probe is brought close to the organ to be studied using an endoscope. It is useful for researching or examining lesions and the surrounding organs. It enables tissue samples to be taken by puncture, so they can be studied in cytology. Saint-Luc University Clinics have developed the technique since its introduction in 1986 and are seen as a European leader in this area. Click here to learn more about this technique.
Scintigraphy in the marked octreotide “octréoscan®”, is used in the diagnosis and in the study of the spread of endocrine tumours. At the Saint-Luc University Clinics, the nuclear medicine service was the first to carry out this examination in Belgium.
Treatment
Cancers of the pancreas can only be operated on from the outset in 15 to 20 % of cases. When the tumour is present in a regionalised spread, the treatment consists of a combination of radiotherapy and chemotherapy, sometimes followed by surgery. In the event of the spread being more considerable and of metastases, we turn to classic chemotherapy and/or new medications which have resulted from research findings.
In cancer of the liver, hepatic transplant opens up perspectives of complete cure, with a survival rate equal to that of patients who have had transplants for reasons other than cancer, that is a 70-80% chance of survival after 5 years. Cancers of the liver currently make up 40% of the indications of hepatic transplant at Saint-Luc. When transplantation is not possible, we turn to other exeresis treatments. These are based on surgery when this is possible, or on radiological techniques known as “interventional” which either allow the active medication to be transported to the tumour site via the vessels which provide the blood supply, or enable the tumour to be cauterized through the skin via an alcohol injection or the emission of a thermo-electric current. The latter technique, known as radiofrequency, destroys tumours by causing hyperthermia.
The treatment of hepatic metastases requires that certain rules be adhered to. Their removal must be complete, yet should also preserve a sufficient quantity of healthy tissue so that the liver can continue to function normally.
It is nonetheless possible, by “portal vein embolization” technique, to increase the volume of the healthy part of the organ, which allows a wider resection of the metastases or the resection of metastases which were initially judged to be inoperable.
The latest chemotherapy medication has also proved to be equally useful in this situation: these reduce the size of the metastases before surgery. There may also be recourse to the radiofrequency technique.
Surgery is the treatment of choice for endocrine tumours and biliary duct tumours, yet it is not always possible to use in these cases. For endocrine tumours, metabolic radiotherapy provides promising results. Carried out in Nuclear Medicine, it consists of injecting radioactive particles against the tumour. However it is only carried out in some specialist centres such as the Erasmus University Hospital in Rotterdam, with which Saint-Luc University Clinics have a very close collaboration.
Surgical interventions intended for the treatment of hepato-bilio-pancreatic tumours can prove to be delicate. The experience which our surgical team has acquired in carrying out this type of intervention is decisive.
It enables transplants in the event of liver cancer, resection of hepatic metastases and complex surgery which endocrine tumours and biliary ducts require, to be successfully carried out.
Research
Hepato-bilio-pancreatic tumours are the subject of a lot of research. The intention is not only to optimise therapeutic approach, but also to make an early diagnosis, in turning to specific new tracers, which are used in Nuclear Medicine in our centre.
Research also leads to the discovery of new medication. These are used in the context of international studies in which our centre actively participates, so as to offer patients the most efficient medication.
Finally, in our research laboratories we are studying the mechanisms responsible for the development of primary cancers of the liver and the effects of chemotherapy on hepatic tissue.
