Tackling liver tumors

Nancy Stutzman knows a lot about the precious gift of life. As a labor delivery nurse in Kittery, Maine, she helps bring new lives into the world on a daily basis. But recently, she got a very personal lesson on just how precious - and fragile - life can be.

Last May, Stutzman, was suffering from recurring bouts of gastroesophageal reflux disease (GERD) or heartburn. Her primary care physician in Maine gave her an ultrasound to rule out gall bladder disease. What the ultrasound found was even more serious.

"The ultrasound showed a suspicious looking tumor on my liver. It was an incidental pickup and totally unexpected," recalls Stutzman.

Her physician gave her the option of doing a liver biopsy to see if the tumor was cancerous, or waiting three months to see if the tumor changed. Nancy was not interested in waiting. She had the biopsy.

"The good news was the tumor was benign," says Stutzman. "The bad news was they couldn't identify the cells and wanted me to wait another three months to repeat the biopsy."

Stutzman wasn't comfortable with waiting, and went to a larger medical center nearby for a second opinion. She decided to make the trip to Boston for a second opinion at Beth Israel Deaconess Medical Center's Liver Tumor Center, one of the only multi-disciplinary, rapid-access liver tumor centers in the world.

Time is crucial when dealing with liver tumors, says Dr. Gerond Lake-Bakaar, Co-Director of BIDMC's Liver Tumor Center.

"Liver cancers grow and grow quickly. While mortality rates for most cancers are going down, for liver cancer, they're going up," says Lake-Bakaar. "Liver cancer has the highest mortality rate because the tumor growth is so rapid that often, by the time you diagnose the cancer, it has already spread and most patients die within a year."

According to the American Cancer Society, the five-year survival rate for liver cancer patients is just 10 percent, mostly because liver cancer patients often have other liver problems such as hepatitis or cirrhosis, which itself can be fatal. But when liver tumors are caught early and treated properly, the outcomes for liver cancer improve dramatically.

"The most important thing to remember about liver tumors is if you find them before they get too big and deal with them, you can be cured," notes Lake-Bakaar.

Every Thursday, some 20 specialists at the center - oncologists, hepatologists, surgeons, radiologists, pathologists and others - gather to review challenging liver tumor cases, share information, discuss diagnosis and talk about the best course of treatment.

"It's the one place where all the specialties involved are there together," says Lake-Bakaar. "We're able to look at everything together and decide together on a treatment option - often before we even see the patient."

In Nancy Stutzman's case, the Liver Tumor team of specialists had to first diagnose the problem - and it was not a straight-forward case. According to the radiologist, a special contrast MRI showed the tumor was benign. But the pathologist saw signs of adenoma, which meant the tumor had the potential to become malignant. The surgeon, Douglas Hanto MD, agreed, and gave Stutzman her options.

"He said, 'We can wait and watch and do another MRI in three months or we can remove it and then you won't have to worry about it,'" recalls Stutzman. "I said, 'Can you do it tomorrow?''

It wasn't the next day, but two weeks later. The tumor was gone, and Stutzman was on the road to recovery.

"Rapid diagnosis and treatment is important when you're dealing with liver cancer," notes Lake-Bakaar. "You take the anxiety factor out for the patient. You can have the best surgeon in the world, but if that surgeon can't see you for six months the game is over."

Surgery is one treatment option, but BIDMC offers many others that are not available at other institutions. For example, it was the first hospital in New England to provide CyberKnife radiosurgery-a sophisticated, robotic non-invasive system that can target radiation with extreme accuracy to treat certain types of cancer, particularly liver tumors.

As for Stutzman, today she is 58-years old, cancer free and back at work, helping bring new lives into the world. She's also enjoying her new lease on life with her four children, two grandchildren and husband of 36 years and is thankful she made the trip down from Maine to the BIDMC Liver Tumor Clinic.

"I'm back to living again," she says. "They saved my life and I will always be forever grateful for the liver center."