Hepatobiliary and Pancreatic Cancer Program

If you have been diagnosed with liver or pancreatic cancer, Providence can help. Our liver and pancreatic cancer experts provide the personalized treatment and support you need.

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Providence Hepatobiliary and Pancreatic Cancer Program

503-215-6014

Providence Hepatobiliary and Pancreatic Cancer Program

Our Providence Hepatobiliary and Pancreatic Cancer Program serves patients with disorders of the liver, bile ducts, gallbladder and pancreas. Our team of experts offers many services as a “single-source” center for patients.

At Providence, we use a multidisciplinary approach for your treatment. This means we meet as a group – medical oncologists, surgeons, radiologists, radiation oncologists, pathologists, oncology nurse navigators, social workers and other experts. Having different viewpoints helps us tailor treatment plans to each person’s needs. Whether you could benefit from radiation, surgery or a clinical trial, we have options to help.

Patient Resources

Hepatobiliary cancers are cancers that start in any of the organs that make up the hepatobiliary system. These types of cancer include:

  • Liver cancer
  • Bile duct cancer
  • Gallbladder cancer

The organs in the hepatobiliary system work together to give the body bile. The liver makes the bile, the bile duct transfers it, and the gallbladder stores it. Bile helps the body break down fatty foods.

What causes liver cancer?

When cells grow out of control in any of the hepatobiliary organs, cancer forms.

The most common risk factor for liver cancer is chronic hepatitis (B or C) virus infection, or long-term, heavy alcohol use. Liver cancer can also be caused by fatty liver disease or long-term use of certain medications. These infections lead to cirrhosis of the liver. Cirrhosis is a serious scarring of the liver that builds up after decades of inflammation. People with cirrhosis have an increased risk of liver cancer.

Additional details

Pancreatic cancer is caused when cells in your pancreas are damaged or have mutations in their DNA. The pancreas is a 6-inch-long gland that sits between the stomach and spine. When damaged pancreatic cells multiply, they often can spread to other areas of the body.

What causes pancreatic cancer?

The exact cause of pancreatic cancer isn’t fully understood. Most pancreatic cancer is random or caused by lifestyle habits, such as smoking or being overweight, or old age. Some pancreatic cancers are genetic. About 10% of all pancreatic cancers are due to an inherited gene mutation, which is associated with a strong family history of pancreatic cancer.

Types of pancreatic cancer

Different types of cancers develop in different parts of the pancreas. The two most common types are:

  • Pancreatic adenocarcinoma: Cancer that develops in the glandular tissue of the pancreas. Glandular tissue, which includes glands and ducts, makes up 98% of the pancreas and produces enzymes to help digest food. Adenocarcinoma is the most common type of pancreatic cancer.
  • Islet cell cancer (also known as pancreatic neuroendocrine tumors, or NETs): Cancer that develops in the neuroendocrine cells, or islet cells, of the pancreas. The other 2% of the pancreas is made up of islet cells, which release insulin and other hormones. Islet cell cancer develops more slowly and is often easier to treat.
  • Additional details

Cancer happens when your DNA changes. These changes are influenced by genetic, environmental and lifestyle factors. For many cancers, it’s not clear what causes the DNA change that leads to cancer. However, medical experts have found certain risk factors may increase a person’s chances of developing cancer.

Overall, having one or more of the listed symptoms does not mean you have cancer. It is important to check with your doctor if you are having any medical concerns or changes in your health.

Resources
  • Pancreatic cancer risk factors and symptoms

    About 10% of pancreatic cancer is inherited. If you have a first-degree relative (mom, dad, sister, brother) with pancreatic cancer, you might be more likely to get it. Other risk factors include:

    • African American or Ashkenazi Jew – people of this descent are more likely to develop pancreatic cancer
    • Chronic pancreatitis, which may be due to heavy alcohol use or an inherited gene mutation
    • Diabetes for a long time
    • Diets high in red or processed meat or high in fat
    • History of certain types of pancreatic cysts, such as mucinous cystic neoplasms and intraductal papillary mucinous neoplasms (IPMN)
    • Obesity (being overweight)
    • Older age
    • Smoking

    Most symptoms of pancreatic cancer are not noticeable. Symptoms may include:

    • Nausea or vomiting
    • Pain in the back or stomach area
    • Recent diabetes diagnosis
    • Swelling in the pancreas (pancreatitis)
    • Weight loss or poor appetite
    • Yellowing of the skin or eyes (jaundice)
  • Liver cancer risk factors and symptoms

    There is a slight hereditary component to liver cancer, but it’s not very strong. Your family history can increase your odds of having conditions that lead to liver cancer. Risk factors for liver cancer include:

    • Asian or African descent
    • Cirrhosis – develops when liver cells are damaged and replaced by scar tissue
    • Heavy alcohol use
    • Obesity (being overweight) with non-alcoholic fatty liver disease (NAFLD)
    • Smoking
    • Type 2 diabetes
    • Viral Hepatitis B or C

    Signs and symptoms of liver cancer often don’t appear until the later stage of the disease. Some of the more common symptoms include:

    • Easy bleeding or bruising
    • Nausea or vomiting
    • Swelling or pain in the liver, spleen or stomach area (near right shoulder blade), or legs
    • Weight loss and loss of appetite
    • Yellowing of the skin or eyes (jaundice)
  • Bile duct cancer risk factors and symptoms

    People with long-term inflammation of the bile ducts have a higher risk of developing bile duct cancer. Certain conditions of the liver or bile ducts can cause this inflammation. These include bile duct stones, cirrhosis, hepatitis B or C, or primary sclerosing cholangitis (PSC). Other risk factors include:

    • Diabetes
    • Ethnicity – Hispanic Americans are at the highest risk
    • Heavy alcohol use
    • Inflammatory bowel disease
    • Non-alcoholic fatty liver disease (NAFLD)
    • Obesity (being overweight)
    • Older age
    • Smoking

    Bile duct cancer is rare. Sometimes people with bile duct cancer do not have any signs and symptoms. First signs and symptoms of bile duct cancer are similar to liver cancer:

    • Abdominal (belly) pain
    • Dark urine and/or lighter-colored stool
    • Fever
    • Itching
    • Nausea or vomiting
    • Weight loss and loss of appetite
    • Yellowing of the skin or eyes (jaundice)
  • Gallbladder cancer risk factors and symptoms

    Many of the risk factors for gall bladder cancer are related to irritation and swelling in the gallbladder that lasts for a long time. Other risk factors include:

    • Ethnicity – Mexican Americans and Native Americans are at higher risk
    • Sex – Females are at higher risk
    • Gallbladder polyps or cysts
    • Gallstones – the most common risk factor
    • Obesity (being overweight)
    • Older age (average age is 72)
    • Porcelain gallbladder

    Gallbladder cancer is rare. Symptoms usually appear after the tumor is large or has spread to other parts of the body. Sometimes you may notice:

    • Dark urine and/or lighter-colored stool
    • Lumps in the stomach area
    • Nausea or vomiting
    • Stomach area pain
    • Yellowing of the skin or eyes (jaundice)

When cancer is found early, chances of survival are much higher. Learn more about how doctors find and diagnose cancer.

  • Pancreatic cancer

    The pancreas is located deep inside the body. It is hard for doctors to see or feel any early pancreatic cancer signs during a physical exam. Symptoms often aren’t obvious. And you may not notice any symptoms until the cancer is very advanced. There’s no standard test to diagnose pancreatic cancer. A tumor in the pancreas is only visible with a computed tomography (CT) scan or magnetic resonance imaging (MRI).

    If a specialist sees a tumor through a scan, they will take a sample of the tumor (called a biopsy). This test helps figure out what the tumor is and if it’s cancerous.

  • Pancreatic cysts and pseudocysts

    Some scans might show that you have a pancreatic cyst or pseudocyst.

    • A cyst is a pocket or collection of fluid with a lining like the lining of your pancreatic ducts.
    • A pseudocyst is a collection of fluid with a capsule or scar tissue surrounding it.

    On imaging, cysts and pseudocysts can appear similar. They behave differently due to their lining and how they form. This allows us to differentiate between the two. Most are not cancerous and do not cause symptoms. However, some cysts can become cancerous and do require surgery or other treatment.

    Pseudocysts

    Pseudocysts are often the result of pancreatitis (inflammation of the pancreas). Pancreatitis is usually caused by heavy alcohol use or gallstones. A pseudocyst will never become cancer and will sometimes go away on its own. If it does not cause symptoms, it may be safely left alone. Sometimes, it will grow, get infected or cause significant symptoms, and it will need to be drained or require surgery.

    Serous Cystadenomas

    These cysts contain thin, watery fluid. They generally do not become cancer or increase the risk of cancer. Surgery is occasionally recommended when they cause symptoms or when they have the appearance of a more suspicious cyst.

    Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms (IPMN)

    Both kinds of cysts contain a protein called mucin and have some risk of becoming a cancer.

    • When IPMNs are in the main pancreatic duct, the risk of developing pancreatic cancer is much higher. In this case, surgery is recommended.
    • When IPMNs are along smaller ducts, the risk of cancer is lower. In this case, your care team will evaluate the best treatment option.

    For people who do not undergo surgery, regular screening (imaging and lab tests) is recommended. This can help to catch any possible cancer early. For cysts that are higher risk, continued screening of the pancreas is necessary, even after surgical removal.

  • Liver cancer

    Liver cancer (and other hepatobiliary cancers) often doesn’t have symptoms until the cancer is more advanced. But your doctor can do a blood test at your routine annual check-up to assess the general health of your liver. This simple blood test looks for any signs of inflammation or swelling in the liver that could lead to cirrhosis.

    If results of a blood test are normal, there is no need for other types of liver tests. If your blood test shows first signs of liver damage, you also may need these tests:

    • CT scan to look for visual signs of cirrhosis
    • Biopsy to confirm diagnosis of cirrhosis or fibrosis (which leads to cirrhosis)
    • Regular ultrasound screenings of your liver

    People at a high risk for developing liver cancer should be screened every 6 months. Liver cancer can be avoided with preventative health screenings. People at high risk include:

    • Anyone with cirrhosis from any cause; hepatitis C, hepatitis B, alcohol and fatty liver disease are the most common causes of cirrhosis in the United States.
    • Persons of Asian descent with chronic hepatitis B (men aged 40 and over, women aged 50 and over).
    • Persons of African descent, aged 20 and over, with chronic hepatitis B.
    • Persons of any age with chronic hepatitis B and a family history of liver cancer.

At Providence, we have a team approach to cancer treatment. Our expert hepatobiliary surgeons, interventional radiologists, medical oncologists and radiation oncologists work together closely to find the best options for you. These teams meet weekly to discuss treatment plans and new therapies.

Resources
Pancreatic cancer treatment

The Providence Cancer Institute has an expert medical and surgical program for pancreatic cancer. A third of all pancreatic cancer patients in Oregon come to us for their treatment because we offer expertise that no one else in the state offers.

Types of treatment for pancreatic cancer include:

  • Surgical options

    Surgical options involve some minimally invasive techniques and robotic surgery. Examples include:

    Whipple procedure (pancreatoduodenectomy): This procedure is for patients with cancer in the head of the pancreas. The surgeon removes part of the pancreas, common bile duct and gallbladder. Then, they create new connections between remaining organs to restore normal gastrointestinal function.

    Whipple Procedure Diagram

    Distal pancreatectomy/splenectomy: This procedure is used for patients with disease in the tail of the pancreas. The surgeon removes part of the pancreas, along with the splenic artery and vein. They may also remove the entire spleen and any lymph nodes along the blood vessels.

    Distal Pancreatectomy Diagram

    Radiofrequency ablation (RFA): This technique uses a “heating probe” to destroy cancer cells.

  • Targeted chemotherapy and immunotherapy

    These treatments can be used together or separately to target cancer cells. Drugs may be injected into a vein or taken by mouth to enter the bloodstream and treat the cancer. Providence has been developing new immunotherapy treatments for over 25 years. Providence is also known globally for robust research and breakthrough treatments offered to patients.

  • Radiation therapy

    Providence offers multiple types of radiation therapy, including new MRI-guided radiation therapy (MR-Linac).

  • Clinical trials

    Patients who participate in clinical trials often gain access to experimental treatments and help others by improving and advancing medical care. View the latest clinical trial offerings.

Liver cancer treatment

Treatment for liver cancer depends on the stage of the cancer.

For early stages of liver cancer, treatments may include:




  • Ablation

    Ablation involves removing body tissue. There are two common types of ablations for liver cancer treatment:

    • Radiofrequency or microwave ablation: If tumors are small, they can be destroyed with a type of heat.
    • Ethanol ablation: If the tumors are small, injecting the body with ethanol may kill the tumor cells.
  • Surgical resection

    Liver cancer may be removed surgically.

  • Radioembolization yttrium-90

    Cancer-fighting radiation is delivered directly to liver tumors by injecting them with millions of tiny beads coated with a safe radioactive element called yttrium-90. These beads block blood supply to the tumor, destroying cancer cells. Tumors that respond to radiation, chemotherapy or yttrium-90 can sometimes then be removed surgically. In some cases, patients are also eligible for a liver transplant.

  • Radiation therapy

    Providence offers multiple types of radiation therapy, including new MRI-guided radiation therapy (MR-Linac). This technology can deliver more precise radiation treatment because of its ongoing MRI monitoring of organ movement during treatment. MR-Linac decreases damage to healthy tissues and organs. It provides stronger, shorter and more effective radiation therapy, compared to standard methods.

  • Targeted chemotherapy and immunotherapy

    Chemotherapy and immunotherapy can be used together or separately to target cancer cells. These drugs may be injected into a vein or taken by mouth to enter the bloodstream and treat the cancer. Providence has been developing new immunotherapy treatments for over 25 years. Providence is also known globally for robust research and breakthrough treatments offered to patients.

Clinical trials are research studies that test whether new medical treatments, devices or plans are safe and effective. At Providence, our hepatobiliary and pancreatic specialists work directly with our researchers. Patients who volunteer for clinical trials play an active role in their own health care. They often gain access to experimental treatments and help others by improving and advancing medical care.

National Pancreas Foundation Center of Excellence LogoAt Providence, we are a leader in cancer research and treatment. The National Pancreas Foundation recognized Providence Cancer Institute as a Center of Excellence for pancreatic cancer care – one of the only centers in Oregon. Our skilled specialists are ready to help you learn more about the first signs, signals and symptoms of liver cancer and pancreatic cancer. We’re dedicated to providing the best care no matter your diagnosis.

Related Resources

An expert breakdown of pancreatic cancer

Researchers at Providence are actively seeking better ways to offer immunotherapy and advance care for patients with pancreatic cancer. Hear from Paul Hanson, M.D., a specialist at the Providence Cancer Institute. He shares expert insights on pancreatic cancer and future pancreatic cancer treatment.

Patient with stage 4 pancreatic cancer shatters trial records

Have you ever wanted to know what it’s like to be in a clinical trial? A patient treated at Providence Southwest Washington shares his journey through a clinical trial with stage 4 pancreatic cancer.