Primary Liver Cancer: Hepatocellular carcinoma (HCC) is the most common type of common primary liver cancer and is associated with more than one million cases diagnosed worldwide each year. Other histologic types, including intrahepatic cholangiocarcinoma, while less common than HCC, are also experiencing a rise in incidence in the United States in recent years (1, 2). Complex management options confront those treating patients with primary liver cancer, making a multi-disciplinary team comprising hepatologists, diagnostic and interventional radiologists, medical oncologists, radiation oncologists, transplant surgeons and surgical oncologists important for optimal care. In patients without cirrhosis, surgical resection of primary liver cancer with partial hepatectomy is the treatment of choice; however, no more than 30% of patients have resectable disease, and when cirrhosis is present, fewer than 10% are resectable (3, 4). The presence of extrahepatic disease, lack of sufficient hepatic function reserve, multi-focal disease within the liver and suboptimal tumor location are all common reasons for unresectability in these patients. Hepatic Metastases: Metastatic disease is the most common malignancy of the liver in the United States. The liver is the most common site for developing metastases, accounting for more than one-half of cases of advanced cancer. Although primary tumors originating from gastrointestinal sites are more likely than others to develop hepatic metastases, many tumors arising in other locations, including those of the breast and lung, also commonly develop hepatic metastases.
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