{"id":5403,"date":"2024-12-11T10:25:36","date_gmt":"2024-12-11T09:25:36","guid":{"rendered":"https:\/\/irccs.com\/patologie\/tumors-of-the-liver-and-biliary-tract\/"},"modified":"2026-04-03T14:31:32","modified_gmt":"2026-04-03T12:31:32","slug":"tumors-of-the-liver-and-biliary-tract","status":"publish","type":"pathology","link":"https:\/\/irccs.com\/en\/patologie\/tumors-of-the-liver-and-biliary-tract\/","title":{"rendered":"Tumors of the Liver and Biliary Tract"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p>Liver cancer can be <strong>primary<\/strong>, originating directly from liver cells, or <strong>secondary<\/strong>, arising as a metastasis from tumors in other organs. Because the liver filters blood from throughout the body, it is one of the organs most frequently affected by metastases, along with the lungs.<\/p>\n\n\n\n<p>Liver cancer is among the most complex cancers to treat, largely because it is often diagnosed at an advanced stage. Nevertheless, <strong>early detection and the targeted therapies now available <\/strong>can improve the chances of effective treatment and disease control.<\/p>\n\n\n\n<p>Globally, primary liver cancer <strong>is the fifth most common malignancy<\/strong>, with incidence varying widely by region: it is particularly prevalent in Asia, while lower rates are observed in Europe and the United States.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types of Liver Cancer<\/h3>\n\n\n\t<div id=\"block_69cfb3231abda\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Primary Tumors<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Primary liver cancers originate directly from liver tissue. The main types are:<\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li><strong>Hepatocellular Carcinoma (HCC)<\/strong>: accounts for approximately 75\u201385% of primary liver cancers. It arises from hepatocytes, the main liver cells, and <strong>often develops in a liver already affected by cirrhosis or chronic hepatitis<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Intrahepatic cholangiocarcinoma<\/strong>: develops from the cells lining the bile ducts within the liver. It is less common than HCC but has been increasing in incidence in recent years<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Rare cancers<\/strong>: including <strong>hepatoblastoma<\/strong> (most common in children), <strong>hepatic angiosarcoma<\/strong>, and other sarcomas, which are very rare in adults<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Secondary Tumors<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Liver metastasis are <strong>far more common than primary liver tumors <\/strong>and results from the spread of cancer cells from other organs, including the colon and rectum, pancreas, stomach, lungs, breast, or skin (melanoma).<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p>In Italy, according to data from the <strong><a href=\"https:\/\/www.registri-tumori.it\/cms\/pubblicazioni\/i-numeri-del-cancro-italia-2023\">AIRTUM Registry<\/a><\/strong>, about <strong>12,200 new diagnoses<\/strong> <strong>of primary liver cancer<\/strong> were registered in 2023 (male-to-female ratio 2 to 1), accounting for about <strong>3 percent of all cancers<\/strong> diagnosed each year.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p>Primary tumor of the liver may give <strong>late and unspecific symptoms.<\/strong><br>The most common signs include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pain or discomfort <\/strong>in the upper abdomen<\/li>\n\n\n\n<li>Digestive difficulties and a sense of fullness<\/li>\n\n\n\n<li>Nausea<\/li>\n\n\n\n<li>Unintentional weight loss<\/li>\n\n\n\n<li><strong>Yellowish discoloration <\/strong>of skin and eyes <em>(jaundice<\/em>)<\/li>\n<\/ul>\n\n\n\n<p><strong>Gallbladder cancer<\/strong> is often difficult to diagnose because the organ is hidden behind other abdominal structures, including the stomach, small intestine, liver, and spleen. Its symptoms can mimic those of more common conditions, such as gallstones or gallbladder infections, and in the early stages, the disease may produce no noticeable symptoms.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>More than 70% of cases of primary<\/strong> liver <strong>tumors<\/strong> are attributable to <strong>hepatitis C virus<\/strong> (HCV) and <strong>hepatitis B virus (HBV<\/strong> ) <strong>infection<\/strong><\/li>\n\n\n\n<li>Dietary <strong>aflatoxin<\/strong> intake (particularly in East Asia and sub-Saharan Africa), <strong>hemochromatosis<\/strong>, <strong>alpha-1-antitrypsin deficiency<\/strong>, <strong>obesity<\/strong> (especially if complicated by the presence of diabetes), and <strong>nonalcoholic steatohepatitis<\/strong><\/li>\n\n\n\n<li><strong>Tobacco smoke<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and Examination<\/h2>\n\n\n\n<p>The diagnostic course usually begins with <strong>blood tests<\/strong> and <strong>ultrasound of the abdomen<\/strong>. If necessary, more in-depth examinations such as <strong>computed tomography (CT) with contrast medium<\/strong> and\/or <strong>magnetic resonance imaging<\/strong> (cholangio-RM) are performed. The results are evaluated by a <strong>medical specialist<\/strong>, who sets the most appropriate diagnostic-therapeutic course.<\/p>\n\n\n\n<p>Once the presence of a tumor is confirmed, additional investigations are performed to determine whether the disease has spread to other parts of the body. This process, called staging, is crucial for selecting the most appropriate treatment. Staging typically involves a contrast-enhanced <strong>CT scan<\/strong> of the <strong>chest <\/strong>and <strong>abdomen<\/strong>, and may include other targeted examinations.<\/p>\n\n\n\n<p>The <strong>stage <\/strong>of the cancer indicates the size of the tumor and whether other organs are affected &#8211; information that is essential for tailoring treatment and maximizing the chances of a successful outcome.<\/p>\n\n\n\t<div id=\"block_69cfb3231ac7c\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Ultrasound<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><strong>Ultrasound<\/strong> is usually the <strong>first imaging test<\/strong> performed when symptoms suggest possible liver disease. It can often identify benign lesions, such as cysts or hemangiomas, but solid lesions typically require further evaluation with more detailed imaging, such as a CT scan.<\/p>\n<p>Ultrasound can also provide important initial information about the presence, extent, and distribution (unilateral or bilateral) of biliary tract dilation, and may help raise early suspicion of possible gallbladder cancer.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">CT Scan Chest and Abdomen<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"271\"><strong data-start=\"0\" data-end=\"127\">Chest and abdominal computed tomography (CT) with quadraphasic contrast (late arterial, portal, venous, and delayed phases)<\/strong> is a key tool for detecting liver lesions and often characterizing them based on their appearance and contrast uptake during the four phases.<\/p>\n<p data-start=\"273\" data-end=\"330\">This examination also provides detailed information on:<\/p>\n<ul data-start=\"331\" data-end=\"676\">\n<li data-section-id=\"t0jygt\" data-start=\"331\" data-end=\"392\">The location of lesions within the eight hepatic segments<\/li>\n<li data-section-id=\"c6mmk4\" data-start=\"393\" data-end=\"439\">Involvement of vascular or portal branches<\/li>\n<li data-section-id=\"14609jk\" data-start=\"440\" data-end=\"478\">Presence of portal vein thrombosis<\/li>\n<li data-section-id=\"v9bv8d\" data-start=\"479\" data-end=\"532\">Biliary tract dilatation and sites of obstruction<\/li>\n<li data-section-id=\"9mmlp6\" data-start=\"533\" data-end=\"588\">Volume of the remaining liver for surgical planning<\/li>\n<li data-section-id=\"83v8k7\" data-start=\"589\" data-end=\"615\">Vascular abnormalities<\/li>\n<li data-section-id=\"e1nx9y\" data-start=\"616\" data-end=\"676\">Presence of distant metastases or suspicious lymph nodes<\/li>\n<\/ul>\n<p data-start=\"678\" data-end=\"791\" data-is-last-node=\"\" data-is-only-node=\"\">All of these details are essential for accurate diagnosis, staging, and planning of potential surgical treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Magnetic Resonance Imaging<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"114\"><strong data-start=\"0\" data-end=\"77\">Liver magnetic resonance imaging (MRI) with hepatospecific contrast agent<\/strong> can be useful in certain cases to:<\/p>\n<ul data-start=\"115\" data-end=\"289\">\n<li data-section-id=\"fszcvb\" data-start=\"115\" data-end=\"182\">Improve characterization of liver lesions detected on a CT scan<\/li>\n<li data-section-id=\"4r024n\" data-start=\"183\" data-end=\"289\">Identify lesions not visible on CT using specialized sequences, such as <strong data-start=\"257\" data-end=\"287\">diffusion-weighted imaging<\/strong><\/li>\n<\/ul>\n<p data-start=\"291\" data-end=\"440\"><strong data-start=\"291\" data-end=\"329\">Cholangiography MRI (Cholangi MRI)<\/strong> is a specialized MRI technique that visualizes the intrahepatic and extrahepatic bile ducts, allowing it to:<\/p>\n<ul data-start=\"441\" data-end=\"579\">\n<li data-section-id=\"yvx51k\" data-start=\"441\" data-end=\"523\">Better characterize strictures and determine the level of biliary obstructions<\/li>\n<li data-section-id=\"5k42u0\" data-start=\"524\" data-end=\"579\">Evaluate congenital abnormalities of the bile ducts<\/li>\n<\/ul>\n<p data-start=\"581\" data-end=\"777\" data-is-last-node=\"\" data-is-only-node=\"\">It is almost always used in cases of <strong data-start=\"618\" data-end=\"637\">Klatskin tumors<\/strong> (tumors of the extrahepatic bile ducts at the biliary confluence) or in certain <strong data-start=\"718\" data-end=\"751\">hilar-type gallbladder tumors<\/strong> that mimic these lesions.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Tumor Markers<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"116\">Blood tests can also measure the levels of two proteins produced by liver tumor cells, known as <strong data-start=\"96\" data-end=\"113\">tumor markers<\/strong>:<\/p>\n<ul data-start=\"118\" data-end=\"292\">\n<li data-section-id=\"qknee5\" data-start=\"118\" data-end=\"193\"><strong data-start=\"120\" data-end=\"148\">Alpha-fetoprotein (AFP):<\/strong> often elevated in hepatocellular carcinoma<\/li>\n<li data-section-id=\"6utreh\" data-start=\"194\" data-end=\"292\"><strong data-start=\"196\" data-end=\"236\">Carbohydrate Antigen 19-9 (CA 19-9):<\/strong> may increase in biliary tract and gallbladder cancers<\/li>\n<\/ul>\n<p data-start=\"294\" data-end=\"544\" data-is-last-node=\"\" data-is-only-node=\"\">The concentrations of these markers are generally related to tumor burden and tend to rise as the disease progresses. When present, they are useful for assessing disease severity, monitoring progression, and evaluating the effectiveness of treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Histological and Cytological Analysis<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"185\">The diagnosis of liver tumors can be established through <strong data-start=\"57\" data-end=\"85\">histological examination<\/strong> of a needle biopsy, typically performed via a <strong data-start=\"132\" data-end=\"182\">percutaneous ultrasound- or CT-guided approach<\/strong>.<\/p>\n<p data-start=\"187\" data-end=\"692\">For <strong data-start=\"191\" data-end=\"228\">extrahepatic biliary tract tumors<\/strong>, diagnosis can sometimes be achieved through <strong data-start=\"274\" data-end=\"286\">brushing<\/strong> during <strong data-start=\"294\" data-end=\"351\">endoscopic retrograde cholangiopancreatography (ERCP)<\/strong>. In this procedure, the <strong data-start=\"376\" data-end=\"396\">papilla of Vater<\/strong> is cannulated, contrast is injected into the biliary and pancreatic ducts, and, if needed, a cytological sample of the lesion is collected. ERCP can also be used to place a <strong data-start=\"570\" data-end=\"587\">biliary stent<\/strong> in cases of malignant biliary obstruction that cannot be surgically treated or as a bridge to surgery.<\/p>\n<p data-start=\"694\" data-end=\"920\">In <strong data-start=\"697\" data-end=\"731\">hepatocellular carcinoma (HCC)<\/strong>, diagnosis is often based on characteristic imaging findings combined with elevated <strong data-start=\"816\" data-end=\"823\">AFP<\/strong> levels, or on concordant results from two imaging studies, so a biopsy is not always required.<\/p>\n<p data-start=\"922\" data-end=\"1113\" data-is-last-node=\"\" data-is-only-node=\"\">For <strong data-start=\"926\" data-end=\"967\">biliary convergence (Klatskin) tumors<\/strong>, obtaining a histologic diagnosis is frequently challenging and may require multiple biopsies, with a significant risk of non-diagnostic samples.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Histologic Type or Histotype  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"222\">In tumor diagnosis, the pathologist examines the overall tissue architecture to determine the <strong data-start=\"94\" data-end=\"113\">histologic type<\/strong>. The histologic type has biological significance and provides valuable information for treatment planning.<\/p>\n<p data-start=\"224\" data-end=\"364\"><strong data-start=\"224\" data-end=\"258\">Hepatocellular carcinoma (HCC)<\/strong> is the most common primary liver tumor and originates from the liver\u2019s main cells, the <strong data-start=\"346\" data-end=\"361\">hepatocytes<\/strong>.<\/p>\n<p data-start=\"366\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\"><strong data-start=\"366\" data-end=\"388\">Cholangiocarcinoma<\/strong> arises from the cells lining the bile ducts (<strong data-start=\"434\" data-end=\"452\">cholangiocytes<\/strong>), either within the liver (<strong data-start=\"480\" data-end=\"496\" data-is-only-node=\"\">intrahepatic<\/strong>) or outside it (<strong data-start=\"513\" data-end=\"529\">extrahepatic<\/strong>). Like gallbladder cancer, cholangiocarcinoma is most often of the <strong data-start=\"597\" data-end=\"615\">adenocarcinoma<\/strong> type.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Histologic Grade  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">&#8220;<strong>Histological grade<\/strong>&#8221; or <strong>grading<\/strong><\/span><\/p>\n<p data-start=\"0\" data-end=\"166\">describes how tumor cells appear under the microscope, indicating their degree of differentiation and potential growth rate.<\/p>\n<p data-start=\"168\" data-end=\"248\">Liver, gallbladder, and biliary tract tumors are classified into three grades:<\/p>\n<ul data-start=\"250\" data-end=\"606\">\n<li data-section-id=\"183audl\" data-start=\"250\" data-end=\"349\"><strong data-start=\"252\" data-end=\"276\">Grade 1 (low grade):<\/strong> tumor cells closely resemble normal cells and are well differentiated.<\/li>\n<li data-section-id=\"1jntygy\" data-start=\"350\" data-end=\"453\"><strong data-start=\"352\" data-end=\"394\">Grade 2 (intermediate\/moderate grade):<\/strong> tumor cells show moderate differences from normal cells.<\/li>\n<li data-section-id=\"140qehy\" data-start=\"454\" data-end=\"606\"><strong data-start=\"456\" data-end=\"481\">Grade 3 (high grade):<\/strong> tumor cells are poorly differentiated, meaning they deviate significantly from the normal cells from which they originate.<\/li>\n<\/ul>\n<p data-start=\"608\" data-end=\"689\" data-is-last-node=\"\" data-is-only-node=\"\">Higher-grade tumors tend to grow and spread more quickly than lower-grade tumors.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">The Lymph Nodes  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><strong data-start=\"0\" data-end=\"15\" data-is-only-node=\"\">Lymph nodes<\/strong> are small glands located throughout the abdomen that collect lymph fluid from surrounding tissues, including tumors. If cancer cells enter the lymphatic vessels, they can spread to these lymph nodes, forming <strong data-start=\"224\" data-end=\"248\">lymphatic metastases<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\n<p>Once the diagnosis is confirmed, specialists in the <a href=\"#multi-disciplinary-team\" type=\"internal\" id=\"#multi-disciplinary-team\">multidisciplinary team<\/a> assess multiple factors to develop a <strong>personalized treatment plan.<\/strong> In addition to the tumor type, size, and spread, the patient\u2019s age, overall health, and medical history are also considered. The proposed treatment plan is then reviewed with the patient, presenting alternative options when they provide similar effectiveness.<\/p>\n\n\n\n<p>The choice of treatment strategy depends on the tumor\u2019s characteristics, stage, liver function, and the patient\u2019s general condition, comorbidities, and age.<\/p>\n\n\n\t<div id=\"block_69cfb3231ade0\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Surgery<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Surgery is <strong>offered as a treatment<\/strong> for these types of malignancy, provided the cancer has not spread to adjacent or distant tissues, which would make the tumor inoperable.<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph --><strong>Hepatocarcinoma (HCC)<\/strong><\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph -->For hepatocarcinoma, the surgical approach may involve two options:<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:list --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li><strong>Liver resection<\/strong><br \/>\nIt involves removing the portion of the liver containing the tumor, along with a safety margin of healthy tissue.<br \/>\nThis option is indicated when:<\/p>\n<ul>\n<li>Lesions are few (less than three) and small (less than 3 cm each) or there is only one lesion not exceeding 5 cm; liver function is almost normal.<\/li>\n<\/ul>\n<p data-start=\"0\" data-end=\"232\">Hepatocellular carcinoma (HCC) develops in approximately 80% of cases in a liver already affected by <strong data-start=\"101\" data-end=\"114\">cirrhosis<\/strong>, which may result from viral infections, alcohol use, hemochromatosis (genetic iron overload), or other conditions.<\/p>\n<p data-start=\"234\" data-end=\"364\" data-is-last-node=\"\" data-is-only-node=\"\">It is essential that enough healthy liver tissue remains after surgery to allow the organ to regenerate and maintain its function.<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Liver transplantation (orthotopic liver transplantation)<\/strong><br \/>\nIn this procedure, the diseased liver is replaced with a liver from a deceased donor. <strong data-start=\"86\" data-end=\"105\">Transplantation<\/strong> is considered when the patient has both a tumor and cirrhosis causing significant liver dysfunction, and is generally limited to patients under 70 years of age. The selection criteria for transplantation are similar to those used for surgical resection.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --><\/p>\n<p><!-- \/wp:list --><\/p>\n<p><!-- wp:paragraph --><strong>Intrahepatic Cholangio Carcinoma (CCC)<\/strong><\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p data-start=\"0\" data-end=\"189\">When feasible, surgical treatment involves <strong data-start=\"43\" data-end=\"64\">hepatic resection<\/strong>, removing the portion of the liver containing the tumor while preserving enough healthy liver to maintain proper function.<\/p>\n<p data-start=\"191\" data-end=\"500\" data-is-last-node=\"\" data-is-only-node=\"\">The procedure is performed with a <strong data-start=\"225\" data-end=\"248\">disease-free margin<\/strong> and typically includes removal of lymph nodes from the <strong data-start=\"304\" data-end=\"323\">hepatic pedicle, <\/strong>the structure containing the portal vein, hepatic artery and its branches, and the main bile duct, since this type of tumor frequently spreads through nearby lymphatic pathways.<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph --><strong>Perilary cholangiocarcinoma (Klatskin tumor)<\/strong><\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph -->This type of tumor, which affects the central part of the biliary tract, usually requires complex surgery.<br \/>\nTreatment involves removal of the <strong>main biliary pathway<\/strong> along with <strong>extensive liver resection<\/strong>. In most cases, a <strong>right hepatectomy<\/strong> is performed (removal of segments 5, 6, 7 and 8) extended to <strong>segment 4<\/strong> and <strong>segment 1<\/strong> as well, since they are drained by the affected biliary tract.<br \/>\nThis is followed by a gentle <strong>reconstruction of the biliary tract<\/strong> &#8211; which is very thin at that point &#8211; connecting it directly to the small intestine.<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph --><strong>Carcinoma of the gallbladder<\/strong><\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph -->This type of cancer can be diagnosed at different times:<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:list --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li><strong>Before surgery<\/strong> (preoperative diagnosis)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>During a cholecystectomy operation<\/strong> (intraoperative diagnosis)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>After surgery<\/strong>, as an occasional finding on histologic examination of gallbladder removed for other reasons (postoperative diagnosis)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --><\/p>\n<p><!-- \/wp:list --><\/p>\n<p><!-- wp:paragraph -->The type of surgery depends greatly on the time of diagnosis and the stage of the disease:<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:list --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li><strong>Very early tumors (T1a):<\/strong> cholecystectomy alone is sufficient, and in case of postoperative diagnosis, reintervention is not necessary.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Stage T1b tumors:<\/strong> in addition to cholecystectomy, the lymph nodes of the hepatic pedicle must also be removed (lymphadenectomy).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Stage T2 or T3 tumors:<\/strong> lymphadenectomy associated with hepatic resection (segments 4b and 5, or the hepatic bed of the gallbladder) is performed.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --><\/p>\n<p><!-- \/wp:list --><\/p>\n<p><!-- wp:paragraph -->This strategy is indicated in tumors growing toward the portion of the gallbladder in contact with the liver <em>(liver bed type<\/em>).<br \/>\nFor tumors that develop toward the hepatic hilum and biliary pathway, treatment is similar to that for perilar cholangiocarcinoma, with more extensive hepatic resections and removal of the biliary pathway.<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:paragraph -->In some cases, when extensive resection is necessary but the volume of remaining liver is insufficient, techniques can be adopted to stimulate the growth of the part that will be preserved, within 30 to 40 days:<\/p>\n<p><!-- \/wp:paragraph --><\/p>\n<p><!-- wp:list --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li><strong>Preoperative portal embolization (PVE<\/strong><strong>)<\/strong>: by interventional radiology, the branch of the portal vein carrying blood to the part of the liver to be removed is occluded so as to increase the flow and volume of the healthy part.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>Portal ligation<\/strong>: a surgical procedure that ties the portal branch intended for the part to be removed, with the same goal as PVE.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>In addition to the techniques already described (embolization or portal ligation), there are newer methods:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li><strong>ALPPS<\/strong> (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) and <strong>mini-ALPPS<\/strong>: consist of total or partial sectioning of the liver, without immediately removing the diseased part and without further ligation (apart from any already provided). This approach reduces the formation of collateral circles that could return blood to the excluded portion of the liver, thus promoting faster and more consistent growth of the healthy portion.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --><\/p>\n<p><!-- \/wp:list --><\/p>\n<p><strong data-start=\"966\" data-end=\"1033\">Preparation in case of tumors with high bilirubin values<\/strong><\/p>\n<p>In patients with <strong data-start=\"1053\" data-end=\"1083\">perilous cholangiocarcinoma<\/strong> or <strong data-start=\"1086\" data-end=\"1125\">&#8220;hylum type&#8221; gallbladder tumor<\/strong> and elevated bilirubin values, before proceeding with extensive hepatectomy (and possible portal embolization), it is essential to perform <strong data-start=\"1274\" data-end=\"1295\">biliary drainage<\/strong> of the liver, which will need to be preserved.<br data-start=\"1335\" data-end=\"1338\" \/>Drainage is done by inserting a thin tube through the abdominal wall and liver, passing the narrowing of the bile duct. This step helps reduce bilirubin, improves liver function, and optimizes residual liver growth. For this reason, drainage should be performed <strong data-start=\"1664\" data-end=\"1673\">before<\/strong> any portal embolization procedures.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Locoregional Therapies<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"53\" data-end=\"460\">Locoregional therapies are targeted treatments that act directly on the tumor or affected area of the liver without significantly involving the rest of the body.<br data-start=\"267\" data-end=\"270\" \/>They are mainly used in the management of <strong data-start=\"318\" data-end=\"336\">hepatocarcinoma<\/strong>, but may also be proposed in other cases, depending on the assessment of the <strong data-start=\"415\" data-end=\"457\">Interdisciplinary Care Group (GIC)<\/strong>.<\/p>\n<p data-start=\"462\" data-end=\"761\">These treatments include procedures such as <strong data-start=\"511\" data-end=\"529\">thermoablation<\/strong>, <strong data-start=\"534\" data-end=\"558\">chemoembolization<\/strong>, or <strong data-start=\"564\" data-end=\"587\">radioembolization<\/strong>, and are designed to reduce tumor size, control disease progression, and, in some cases, make surgery possible\u2014all using the <strong data-start=\"211\" data-end=\"238\">least invasive approach<\/strong> possible.<\/p>\n<ul>\n<li data-start=\"462\" data-end=\"761\"><strong>Thermoablation:<\/strong> is a minimally invasive procedure that uses heat to destroy the tumor. A thin needle, guided by ultrasound, is inserted directly into the lesion (through the abdominal wall or during surgery). The needle emits <strong data-start=\"347\" data-end=\"360\">microwaves<\/strong> for a time and at an intensity calibrated to the size of the tumor, generating heat that destroys diseased cells. Treatment covers not only the entire lesion but also a small margin of surrounding tissue to reduce the risk of recurrence. It is particularly indicated for <strong data-start=\"659\" data-end=\"698\">tumors less than 3 cm in diameter<\/strong> and, in patients with other diseases, may be preferred to surgery for deep, small lesions;\n<ul>\n<li data-start=\"462\" data-end=\"761\"><strong>Transarterial chemoembolization<\/strong>: the procedure involves the insertion of a thin catheter into the femoral artery, which is traced up to the arteries feeding the liver tumor. Here an <strong data-start=\"311\" data-end=\"337\">embolizing material<\/strong> is released that has a dual action:\n<ul data-start=\"370\" data-end=\"578\">\n<li data-start=\"370\" data-end=\"469\">\n<p data-start=\"373\" data-end=\"469\"><strong data-start=\"373\" data-end=\"403\">blocks blood flow<\/strong> to the tumor, reducing its supply of oxygen and nutrients;<\/p>\n<\/li>\n<li data-start=\"470\" data-end=\"578\">\n<p data-start=\"473\" data-end=\"578\">administers <strong data-start=\"473\" data-end=\"522\">chemotherapeutic drugs locally<\/strong>, so as to target cancer cells.<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li data-start=\"462\" data-end=\"761\">\n<p data-start=\"99\" data-end=\"507\"><strong data-start=\"99\" data-end=\"137\">Transarterial radioembolization: <\/strong>this procedure is similar to chemoembolization, but instead of chemotherapeutic drugs, a substance containing <strong>radioactive microspheres<\/strong> is used.<br data-start=\"294\" data-end=\"297\" \/>The material is released in a targeted manner within the arteries that feed the tumor, so as to directly target it with localized radiation and preserve surrounding healthy tissue as much as possible. Radioembolization may<strong> also be indicated for large lesions (more than 6 cm)<\/strong> and may have either a purely therapeutic purpose or, in some cases, a preparatory role for surgery if the response to treatment is favorable.<\/p>\n<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Chemotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"290\" data-end=\"735\">Chemotherapy uses <strong data-start=\"316\" data-end=\"339\">cytotoxic drugs<\/strong> with the aim of <strong>inhibiting the growth and multiplication of cancer cells until they die.<\/strong> Cancer cells multiply uncontrollably and rapidly &#8211; this characteristic makes them targets for chemotherapy, but it can also involve healthy cells that rapidly renew themselves, causing <strong data-start=\"709\" data-end=\"732\">side effects.<\/strong><\/p>\n<p data-start=\"737\" data-end=\"906\">In <strong data-start=\"741\" data-end=\"762\">liver cancer<\/strong>, chemotherapy is mainly indicated in <strong data-start=\"808\" data-end=\"854\">gallbladder and biliary tract cancers<\/strong>. <strong data-start=\"860\" data-end=\"878\">Hepatocarcinomas<\/strong> rarely benefit.<\/p>\n<h3 data-start=\"913\" data-end=\"944\"><\/h3>\n<h3 data-start=\"913\" data-end=\"944\">When can it be used<\/h3>\n<ul data-start=\"945\" data-end=\"1285\">\n<li data-start=\"945\" data-end=\"1048\">\n<p data-start=\"947\" data-end=\"1048\"><strong data-start=\"947\" data-end=\"987\">Before surgery (neoadjuvant)<\/strong> \u2192reduces the tumor mass to facilitate its removal;<\/p>\n<\/li>\n<li data-start=\"1049\" data-end=\"1164\">\n<p data-start=\"1051\" data-end=\"1164\"><strong data-start=\"1051\" data-end=\"1084\">after surgery (adjuvant)<\/strong> \u2192 reduces the risk of recurrence, depending on stage and risk factors;<\/p>\n<\/li>\n<li data-start=\"1165\" data-end=\"1285\">\n<p data-start=\"1167\" data-end=\"1285\"><strong data-start=\"1167\" data-end=\"1203\">in advanced\/metastatic disease<\/strong> \u2192 reduces symptoms, slows progression, and may prolong survival.<\/p>\n<\/li>\n<\/ul>\n<h3 data-start=\"1292\" data-end=\"1322\"><\/h3>\n<h3 data-start=\"1292\" data-end=\"1322\">Most commonly used drugs<\/h3>\n<p data-start=\"1323\" data-end=\"1395\">Administered alone, in combination, or in sequence, they include:<\/p>\n<ul data-start=\"1396\" data-end=\"1575\">\n<li data-start=\"1396\" data-end=\"1447\">\n<p data-start=\"1398\" data-end=\"1447\">5-fluorouracil (5FU) + folinic acid (intravenously)<\/p>\n<\/li>\n<li data-start=\"1448\" data-end=\"1472\">\n<p data-start=\"1450\" data-end=\"1472\">Gemcitabine (intravenous)<\/p>\n<\/li>\n<li data-start=\"1473\" data-end=\"1496\">\n<p data-start=\"1475\" data-end=\"1496\">Irinotecan (intravenous)<\/p>\n<\/li>\n<li data-start=\"1497\" data-end=\"1520\">\n<p data-start=\"1499\" data-end=\"1520\">Cisplatin (intravenous)<\/p>\n<\/li>\n<li data-start=\"1521\" data-end=\"1546\">\n<p data-start=\"1523\" data-end=\"1546\">Oxaliplatin (intravenous)<\/p>\n<\/li>\n<li data-start=\"1547\" data-end=\"1575\">\n<p data-start=\"1549\" data-end=\"1575\">Capecitabine (intravenous)<\/p>\n<\/li>\n<\/ul>\n<p data-start=\"1577\" data-end=\"1682\">The choice depends on the tumor site, general health status, and treatments already received.<\/p>\n<h3 data-start=\"1689\" data-end=\"1725\"><\/h3>\n<h3 data-start=\"1689\" data-end=\"1725\">Mode of administration<\/h3>\n<ul data-start=\"1726\" data-end=\"2223\">\n<li data-start=\"1726\" data-end=\"1793\">\n<p data-start=\"1728\" data-end=\"1793\"><strong data-start=\"1728\" data-end=\"1741\">Oral route<\/strong> \u2192 tablets or capsules, one or more times a day;<\/p>\n<\/li>\n<li data-start=\"1794\" data-end=\"2223\">\n<p data-start=\"1796\" data-end=\"1963\"><strong data-start=\"1796\" data-end=\"1819\">Intravenous (EV) route<\/strong> \u2192 via needle-cannula or more frequently <strong data-start=\"1863\" data-end=\"1891\">central venous catheters<\/strong>, which allow safe infusions of potentially irritating drugs:<\/p>\n<ul data-start=\"1966\" data-end=\"2223\">\n<li data-start=\"1966\" data-end=\"2050\">\n<p data-start=\"1968\" data-end=\"2050\"><strong data-start=\"1968\" data-end=\"1976\">PICC<\/strong> (peripherally inserted catheter, for medium- to long-term therapies)<\/p>\n<\/li>\n<li data-start=\"2053\" data-end=\"2119\">\n<p data-start=\"2055\" data-end=\"2119\"><strong data-start=\"2055\" data-end=\"2081\">Tunnellized catheter<\/strong> (for medium- to long-term therapy)<\/p>\n<\/li>\n<li data-start=\"2122\" data-end=\"2223\">\n<p data-start=\"2124\" data-end=\"2223\"><strong data-start=\"2124\" data-end=\"2139\">PORT-a-CATH<\/strong> (totally implantable device under the skin, for long-term therapies)<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p data-start=\"2225\" data-end=\"2557\">Infusions take place on an outpatient basis and can last from a few minutes to several hours.<br data-start=\"2312\" data-end=\"2315\" \/>Chemotherapy is administered &#8220;<strong data-start=\"2349\" data-end=\"2360\">in cycles<\/strong>&#8220;: each cycle lasts a few days and is followed by a period of rest to allow the body to recover. The number of cycles depends on the type of tumor and response to treatment.<\/p>\n<h3 data-start=\"2564\" data-end=\"2591\"><\/h3>\n<h3 data-start=\"2564\" data-end=\"2591\">Side effects<\/h3>\n<p data-start=\"2592\" data-end=\"2652\">They can be <strong data-start=\"2607\" data-end=\"2620\">immediate<\/strong>, <strong data-start=\"2638\" data-end=\"2649\">delayed<\/strong>, or <strong data-start=\"2638\" data-end=\"2649\">late-onset<\/strong>:<\/p>\n<ul data-start=\"2654\" data-end=\"3136\">\n<li data-start=\"2654\" data-end=\"2816\">\n<p data-start=\"2656\" data-end=\"2816\"><strong data-start=\"2656\" data-end=\"2669\">Immediate<\/strong> \u2192 nausea, vomiting, fever, rash, diarrhea, heart rhythm disturbances, allergic reactions, local inflammation<span style=\"font-weight: 400;\"> if the drug leaks from the vein;<\/span><\/p>\n<\/li>\n<li data-start=\"2817\" data-end=\"3049\">\n<p data-start=\"2819\" data-end=\"3049\"><strong data-start=\"2819\" data-end=\"2832\">delayed<\/strong> \u2192 decline in red blood cells (anemia), white blood cells (neutropenia), and platelets (plateletopenia), oral or gastrointestinal mucositis, alopecia, peripheral neuropathy (tingling hands and feet), renal\/hepatic damage, cystitis;<\/p>\n<\/li>\n<li data-start=\"3050\" data-end=\"3136\">\n<p data-start=\"3052\" data-end=\"3136\"><strong data-start=\"3052\" data-end=\"3063\">late-onset<\/strong> \u2192 cardiac toxicity, pulmonary fibrosis, infertility, second neoplasms.<\/p>\n<\/li>\n<\/ul>\n<h4 data-start=\"3143\" data-end=\"3192\">Some frequent effects and how to handle them<\/h4>\n<ul data-start=\"3193\" data-end=\"3928\">\n<li data-start=\"3193\" data-end=\"3474\">\n<p data-start=\"145\" data-end=\"414\"><strong data-start=\"145\" data-end=\"182\">Reduced resistance to infection<\/strong><br data-start=\"182\" data-end=\"185\" \/>Chemotherapy can temporarily lower the number of white blood cells, which are essential for defending the body against infection. This can increase the risk of even serious infections, especially if fever occurs. If you have a fever above 38\u00b0C during treatment, it is important to<strong> notify your doctor immediately<\/strong>, as you may need to intervene quickly with specific therapies. To reduce this risk, some patients are given drugs that stimulate white blood cell production, helping the immune system recover faster;<\/p>\n<\/li>\n<li data-start=\"3475\" data-end=\"3529\">\n<p data-start=\"3477\" data-end=\"3529\"><strong data-start=\"3477\" data-end=\"3487\">Anemia<\/strong> \u2192 causes intense fatigue;<\/p>\n<\/li>\n<li data-start=\"3530\" data-end=\"3612\">\n<p data-start=\"3532\" data-end=\"3612\"><strong data-start=\"3532\" data-end=\"3550\">Plateletopenia<\/strong> \u2192 facilitates bruising or small bleeding;<\/p>\n<\/li>\n<li data-start=\"3613\" data-end=\"3773\">\n<p data-start=\"3615\" data-end=\"3773\"><strong data-start=\"3615\" data-end=\"3627\">Alopecia<\/strong> \u2192 hair loss, often rapid 3-4 weeks after initiation of therapy; possible reduction of damage with cooling helmet;<\/p>\n<\/li>\n<li data-start=\"3774\" data-end=\"3844\">\n<p data-start=\"3776\" data-end=\"3844\"><strong>Hand-foot syndrome<\/strong> \u2192 pain and redness of palms and soles;<\/p>\n<\/li>\n<li data-start=\"3845\" data-end=\"3928\">\n<p data-start=\"3847\" data-end=\"3928\"><strong data-start=\"3847\" data-end=\"3878\">Fertility alterations<\/strong> \u2192 to be discussed before initiation of therapy.<\/p>\n<\/li>\n<\/ul>\n<h3 data-start=\"3935\" data-end=\"3973\"><\/h3>\n<h3 data-start=\"3935\" data-end=\"3973\">New therapeutic possibilities<\/h3>\n<p data-start=\"3974\" data-end=\"4275\">Clinical trials are underway to develop drugs that are more selective toward cancer cells<strong> (molecular targeting)<\/strong> and have fewer side effects. In selected cases, the patient may participate in <strong data-start=\"4175\" data-end=\"4192\">clinical trials<\/strong> with innovative therapies or combinations of chemo, targeted therapies, and immunotherapy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Biological Therapies and Immunotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<ul>\n<li><strong data-start=\"0\" data-end=\"24\" data-is-only-node=\"\">Biological therapies<\/strong>, also known as <strong data-start=\"40\" data-end=\"74\">molecularly targeted therapies<\/strong>, are treatments that act on specific molecular targets &#8211; such as receptors, growth factors, or enzymes &#8211; primarily found in cancer cells. These targets play key roles in uncontrolled cell growth and spread, resistance to conventional treatments, and the formation of new blood vessels that support tumor development.<br \/>\n<!-- \/wp:paragraph --> <!-- wp:paragraph --><\/li>\n<li><strong>Immunotherapy<\/strong> includes drugs that are not directed against tumor cells but work <strong>by activating the immune system response<\/strong> inhibited by the tumor.<\/li>\n<li>In cases of advanced hepatocarcinoma, medical therapies include:<br \/>\n&#8211; Tyrosine kinase inhibitors (TKIs) lenvatinib, sorafenib, cabozantinib, regorafenib<br \/>\n&#8211; Combination of immunotherapy (nivolumab) and antiangiogenic drugs (atezolizumab\/bevacizumab)<br \/>\n&#8211; Immunotherapy combinations (durvalumab\/tremelimumab)<br \/>\n&#8211; New agents<\/li>\n<li>In case of <strong>advanced cholangiocarcinoma<\/strong>, <strong>molecular profiling analysis<\/strong> of the tumor is performed to identify by <strong>NGS<\/strong> any specific genetic alterations (affecting FGFR2, IDH1, HER2, BRAF, MMR proteins.). At progression from first-line chemoimmunotherapy some patients<br \/>\nmay benefit from molecularly targeted drugs (depending on the molecular alteration: pemigatinib, ivosidenib, zanidatamab, dabrafenib, trametinib, pembrolizumab) compared to standard therapy, with<br \/>\nA significant impact on prognosis and quality of life.<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Radiation therapy can be used to <strong>treat localized liver tumors when surgery or locoregional treatments are not feasible<\/strong>.<\/p>\n<p><!-- \/wp:paragraph --> <!-- wp:paragraph --><\/p>\n<p>It can also be employed in cases of <strong data-start=\"169\" data-end=\"183\">recurrence<\/strong> or for <strong data-start=\"191\" data-end=\"214\">palliative purposes<\/strong> to relieve symptoms.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Recovery After Surgery &#8211; ERAS protocol<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"109\" data-end=\"162\">At the Candiolo Cancer Institute, post-surgical recovery is guided by the <em data-start=\"258\" data-end=\"291\">Enhanced Recovery After Surgery<\/em> <em data-start=\"258\" data-end=\"291\">(<\/em><strong data-start=\"248\" data-end=\"256\">ERAS<\/strong>) protocol, which is designed to speed up the return to independence, shorten hospital stays, and reduce the risk of complications.<\/p>\n<p data-start=\"468\" data-end=\"703\">This approach involves a <strong data-start=\"498\" data-end=\"524\">multidisciplinary team:<\/strong>\u00a0a surgeon, anesthesiologist, dietitian, nurse, psychologist, physical therapist, and social worker, that follows the patient at every stage, from pre-surgery to return home.<\/p>\n<p data-start=\"705\" data-end=\"753\">The protocol is based on a few key points:<\/p>\n<ul data-start=\"754\" data-end=\"898\">\n<li data-start=\"754\" data-end=\"791\">\n<p data-start=\"756\" data-end=\"791\"><strong data-start=\"756\" data-end=\"789\">effective pain control<\/strong><\/p>\n<\/li>\n<li data-start=\"792\" data-end=\"832\">\n<p data-start=\"794\" data-end=\"832\"><strong data-start=\"794\" data-end=\"830\">minimally invasive surgical techniques<\/strong><\/p>\n<\/li>\n<li data-start=\"833\" data-end=\"867\">\n<p data-start=\"835\" data-end=\"867\"><strong data-start=\"835\" data-end=\"865\">pre-operative counseling<\/strong><\/p>\n<\/li>\n<li data-start=\"868\" data-end=\"898\">\n<p data-start=\"870\" data-end=\"898\"><strong data-start=\"870\" data-end=\"896\">early rehabilitation<\/strong><\/p>\n<\/li>\n<\/ul>\n<p data-start=\"900\" data-end=\"1207\">Measures include avoiding fasting before surgery through adequate <strong data-start=\"994\" data-end=\"1019\">nutritional support<\/strong>, using <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/anesthesia-and-resuscitation\/\"><strong data-start=\"1035\" data-end=\"1055\">targeted anesthesia<\/strong><\/a> that allows rapid natural feeding, limiting the use of tubes, drains, and IVs, and encouraging <strong data-start=\"1178\" data-end=\"1204\">early mobilization<\/strong>.<\/p>\n<p data-start=\"1209\" data-end=\"1287\">The result is a recovery process that is more comfortable, safer, and more effective.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing support<\/h2>\n\n\n\n<p>We provide continuous support throughout the patient\u2019s journey, before, during, and after treatment, ensuring a comprehensive and coordinated care pathway.<\/p>\n\n\n\t<div id=\"block_69cfb3231aed4\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"229\">Treatments for liver cancer can cause side effects that may affect quality of life to varying degrees. However, these effects can often be managed, or even prevented, through specific therapies and appropriate lifestyle measures.<\/p>\n<p data-start=\"231\" data-end=\"454\" data-is-last-node=\"\" data-is-only-node=\"\">At the Candiolo Cancer Institute, doctors and nurses from the <strong data-start=\"277\" data-end=\"309\">multidisciplinary team (GIC)<\/strong> are available to provide patients with comprehensive support to help manage the side effects they may experience during the course of treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Line to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"291\">Cancer patients are often vulnerable and require timely support throughout their treatment journey. When they experience symptoms\u2014whether related to the disease itself or to therapy side effects\u2014they should have rapid access to a specialist\u2019s evaluation through a <strong data-start=\"264\" data-end=\"280\">\u201cfast track\u201d<\/strong> service.<\/p>\n<p data-start=\"293\" data-end=\"611\" data-is-last-node=\"\" data-is-only-node=\"\">For this reason, the Candiolo Cancer Institute offers an assistance service every weekday,\u00a0 from Monday to Friday, from 8:00 a.m. to 5:00 p.m. Patients can call the <strong data-start=\"449\" data-end=\"484\">Oncology Day Hospital secretary<\/strong> at <strong>+39 011 993 3775<\/strong>, report the need for an urgent consultation, and will be promptly contacted by their specialist physician.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Continuing Care and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"219\">Oncology patients are complex and require <strong data-start=\"42\" data-end=\"71\">multidisciplinary support<\/strong> to manage not only their disease but also related issues affecting both physical health\u2014such as pain or weight loss\u2014and psychological well-being.<\/p>\n<p data-start=\"221\" data-end=\"338\" data-is-last-node=\"\" data-is-only-node=\"\">At the Candiolo Cancer Institute, specialists from various disciplines are available to patients who need or request them, providing:<\/p>\n<p><!-- \/wp:paragraph --> <!-- wp:list --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\"><!-- wp:list-item --><\/p>\n<li>nutritional support,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>psychological support,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>physical therapy,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>dressing of venous access devices,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>pain therapy,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/wp:list-item --> <!-- wp:list-item --><\/p>\n<ul class=\"wp-block-list\">\n<li style=\"list-style-type: none;\">\n<ul class=\"wp-block-list\">\n<li>management of other coexisting conditions.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>The Social Service Department of the Candiolo Cancer Institute conducts <strong>information and orientation interviews for patients and their families <\/strong>on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).<\/p>\n<p><!-- \/wp:paragraph --> <!-- wp:paragraph --><\/p>\n<p>The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. &#8211; Phone:<strong> +39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow-Up: What to Expect After Completing Treatment<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"234\">After surgery or completion of treatment, patients enter a program of <strong data-start=\"70\" data-end=\"91\">regular follow-up<\/strong> that typically lasts around five years. These checkups include medical evaluations and selected imaging or diagnostic tests, which serve to:<\/p>\n<ul data-start=\"236\" data-end=\"518\" data-is-last-node=\"\" data-is-only-node=\"\">\n<li data-section-id=\"17s8smt\" data-start=\"236\" data-end=\"306\"><strong data-start=\"238\" data-end=\"263\">Detect any recurrence<\/strong> of the disease, whether local or distant<\/li>\n<li data-section-id=\"1vadgw1\" data-start=\"307\" data-end=\"371\"><strong data-start=\"309\" data-end=\"344\">Monitor and manage side effects<\/strong> from previous treatments<\/li>\n<li data-section-id=\"1q6tbcj\" data-start=\"372\" data-end=\"518\" data-is-last-node=\"\"><strong data-start=\"374\" data-end=\"399\">Assess overall health<\/strong> following therapies such as chemotherapy or radiation, which can occasionally cause long-term effects even years later<\/li>\n<\/ul>\n<p data-start=\"0\" data-end=\"305\">Initially, follow-up visits are scheduled more frequently, with intervals gradually lengthening over time. The <strong data-start=\"111\" data-end=\"149\">frequency and type of examinations<\/strong> are personalized based on the stage of the disease and the treatments received, and will be clearly communicated by the oncologist at the end of therapy.<\/p>\n<p data-start=\"307\" data-end=\"614\" data-is-last-node=\"\" data-is-only-node=\"\">It is important to understand that follow-up primarily aims at <strong data-start=\"370\" data-end=\"410\">early detection of local recurrences<\/strong>. Detecting distant metastases before they cause symptoms has not been shown to improve outcomes. Therefore, additional or more frequent tests than those recommended by the oncologist are <strong data-start=\"598\" data-end=\"613\">not advised<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p>Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At the Candiolo Cancer Institute, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC&nbsp;<\/strong>(Interdisciplinary Care Group or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p>For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<p>The Group<strong>&nbsp;also collaborates closely with the Institute\u2019s researchers<\/strong>&nbsp;to provide patients with rapid access to the latest innovations in screening, diagnosis, and treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p>The diagnostic-therapeutic pathway for liver cancer at Candiolo involves several clinical divisions, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/oncologic-surgery\/\">Oncologic Surgery<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/gastroenterology-and-digestive-endoscopy\/\">Gastroenterology and Digestive Endoscopy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/medical-oncology\/\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/pathologic-anatomy\/\">Pathologic Anatomy<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/radiodiagnostics\/\">Radiodiagnostics<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/nuclear-medicine\/\">Nuclear Medicine<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/radiotherapy\/\">Radiotherapy<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical Studies<\/h2>\n\n\n\n<p>Researchers at the Candiolo Cancer Institute are actively engaged in&nbsp;<strong>numerous research projects<\/strong>, both national and international, dedicated to liver, biliary tract and gallbladder.<\/p>\n\n\n\n<p>Current research efforts focus primarily on developing <strong>new molecular-targeted therapies<\/strong> to treat some forms of liver cancer that have become resistant to standard treatments. In <strong>advanced cholangiocarcinoma<\/strong>, two randomized phase 3 trials are ongoing<br>which respectively evaluate the use of <strong>standard chemotherapy in combination with bispecific anti-HER2 antibody<\/strong> in first-line and <strong>molecularly targeted antiFGFR2 therapies<\/strong> at progression after previous target therapy in subpopulations of patients with these specific molecular characteristics.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p>At Candiolo Cancer Institute, every patient with colorectal cancer is treated in a highly specialized manner, thanks to the synergistic work of a dedicated <a href=\"#multi-disciplinary-team\">Interdisciplinary Care Group (ICG)<\/a>.<\/p>\n\n\n\t<div id=\"block_69cfb3231b8b8\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of liver cancer cases treated each year, the Candiolo Cancer Institute is a <strong>national reference<\/strong> center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a personalized approach, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p>Advanced laboratory tests, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"150\" data-end=\"636\">When appropriate, liver surgeries are performed using <strong data-start=\"244\" data-end=\"268\">minimally invasive<\/strong>, laparoscopic or robotic <strong data-start=\"244\" data-end=\"268\">techniques<\/strong>. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma. Benefits to the patient include shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/p>\n<p data-start=\"638\" data-end=\"906\">The Candiolo Cancer Institute is equipped with <strong data-start=\"673\" data-end=\"709\">state-of-the-art technologies<\/strong>, such as 4K laparoscopic columns and intraoperative fluorescence systems, which give the surgeon an extremely sharp and detailed view, facilitating even the most complex procedures.<\/p>\n<p data-start=\"908\" data-end=\"1110\">Further support comes from the use of <strong data-start=\"955\" data-end=\"985\">indocyanine green (ICG)<\/strong>, a dye that, in combination with the <strong data-start=\"1037\" data-end=\"1048\">Firefly<\/strong> mode found in robotic and laparoscopic systems, enables to:<\/p>\n<ul data-start=\"1111\" data-end=\"1552\">\n<li data-start=\"1111\" data-end=\"1292\">\n<p data-start=\"1113\" data-end=\"1292\"><strong data-start=\"1113\" data-end=\"1157\">Highlight hepatocarcinoma lesions<\/strong> when ICG is injected intravenously about 24 hours before surgery, accumulating in the tumor and making it visible;<\/p>\n<\/li>\n<li data-start=\"1293\" data-end=\"1552\">\n<p data-start=\"1295\" data-end=\"1552\"><strong data-start=\"1295\" data-end=\"1345\">Accurately identify liver segments<\/strong> during a resection: by clamping the vessels that supply blood to a particular segment or sector and injecting ICG during surgery, a visual &#8220;map&#8221; is obtained that guides the surgeon with extreme accuracy.<\/p>\n<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focues on scientific research. Patients can be considered for <strong><a href=\"#studi-clinici\">participation in active clinical trials<\/a><\/strong>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>The Interdisciplinary Care Group\u00a0 (GIC or MDT) <a href=\"#presa-in-carico-completa\"><strong>supports the patient at every stage<\/strong><\/a>: from diagnosis, through treatment, to follow-up. Special attention is paid to nutritional support, psychological health and reintegration into daily life. The organization of checkups, examinations, and treatment is designed to ensure continuity, serenity, and a humane, caring approach to each patient&#8217;s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><\/h3>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5403","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Tumors of the Liver and Biliary Tract - Istituto di Candiolo<\/title>\n<meta name=\"description\" content=\"Learn how the Candiolo Institute treats liver tumors: advanced diagnosis and treatment and opportunities to participate in clinical trials.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/irccs.com\/en\/patologie\/tumors-of-the-liver-and-biliary-tract\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tumors of the Liver and Biliary Tract - 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