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Importance of Multidisciplinary Care in Liver Cancer

Insights From: Arndt Vogel, MD, Hannover Medical School
Published: Friday, Sep 08, 2017



Transcript:

Arndt Vogel, MD: A multidisciplinary approach is clearly required when we decide on the treatment of patients with hepatocellular carcinoma because, in general, patients with hepatocellular carcinoma have 2 diseases: They have underlying liver diseases with liver fibrosis, and they have the tumor. When we decide which treatment is best, we have to take both into account. So how good is the liver function, which treatment can the patient tolerate, and then, of course, we also have to look at the tumor burden itself: What kind of tumor is it? How many tumor nodules? How big are they? And then we can decide what is the best treatment for this specific patient. And to do that, we clearly need a multidisciplinary tumor board. We need the surgeon, the hepatologist, the oncologist, the pathologist, and the radiologist. It’s all part of the team, and together we can decide what is the best treatment.

When we look at the multidisciplinary tumor board, there are colleagues from different departments. First of all, we need to make the diagnosis, and we can’t make the diagnosis based on just imaging. So for that, we need the radiologist. But on the other hand, of course we have a lot of targeted therapies and clinical trials, and sometimes we also need a molecular diagnosis. So the pathologist should clearly be part of the team. These are the 2 colleagues we need for the diagnosis and to see tumor burden. Then we have the hepatologist. The hepatologist will tell us about the liver disease and the liver function, which is quite important. In terms of systemic therapy, it’s usually a mixture. It could be the oncologist and/or the gastroenterologist or hepatologist who will provide the treatment, depending on which country you are in. And then for the local therapies, we would require an interventional radiologist. In some countries, this could also be the interventional gastroenterologist. Of course, we need surgeons. The surgeon can decide on liver transplantation, and if liver transplantation is not an option, partial hepatectomies, for example, are possible for our patient.

I think in HCC, it’s so crucial and really important to make the diagnosis within a multidisciplinary tumor board. And this is not only the case when you start treatment but at each time point when you do the CT scans as follow-up scans to see how the treatment worked, and to decide how to proceed, you really need the tumor board. So if you do not have the opportunity to really discuss your patient along the way of treatment within a tumor board, I would really think you should not treat the patient. It’s really different from other tumors, and in my eyes, it’s because of the underlying liver disease, a little bit more complicated. And the hepatologist and gastroenterologist really need to be part of the team. So patients with HCC clearly should be treated in larger centers with experience in HCC.

Communication within the interdisciplinary tumor board is extremely important because we have all these different members of the different departments, and of course, everybody is trying to provide his treatment and is convinced that his treatment is the best treatment. But still, in most patients, only 1 or 2 treatments are really appropriate and the best choice for the patient. In the past year, I think we have really gotten used to communicating a lot and we have learned a lot. I think we all understand the possibilities each treatment can provide for our patients, and we are getting better to really see the specific opportunities where we can use one or the other treatment. So at the moment, I think it’s not really that difficult anymore to come up with the right decision. It’s really so dependent on tumor burden and liver function that, in most cases, we can really easily come to a decision.

Transcript Edited for Clarity

Brought to you in part by Eisai
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Transcript:

Arndt Vogel, MD: A multidisciplinary approach is clearly required when we decide on the treatment of patients with hepatocellular carcinoma because, in general, patients with hepatocellular carcinoma have 2 diseases: They have underlying liver diseases with liver fibrosis, and they have the tumor. When we decide which treatment is best, we have to take both into account. So how good is the liver function, which treatment can the patient tolerate, and then, of course, we also have to look at the tumor burden itself: What kind of tumor is it? How many tumor nodules? How big are they? And then we can decide what is the best treatment for this specific patient. And to do that, we clearly need a multidisciplinary tumor board. We need the surgeon, the hepatologist, the oncologist, the pathologist, and the radiologist. It’s all part of the team, and together we can decide what is the best treatment.

When we look at the multidisciplinary tumor board, there are colleagues from different departments. First of all, we need to make the diagnosis, and we can’t make the diagnosis based on just imaging. So for that, we need the radiologist. But on the other hand, of course we have a lot of targeted therapies and clinical trials, and sometimes we also need a molecular diagnosis. So the pathologist should clearly be part of the team. These are the 2 colleagues we need for the diagnosis and to see tumor burden. Then we have the hepatologist. The hepatologist will tell us about the liver disease and the liver function, which is quite important. In terms of systemic therapy, it’s usually a mixture. It could be the oncologist and/or the gastroenterologist or hepatologist who will provide the treatment, depending on which country you are in. And then for the local therapies, we would require an interventional radiologist. In some countries, this could also be the interventional gastroenterologist. Of course, we need surgeons. The surgeon can decide on liver transplantation, and if liver transplantation is not an option, partial hepatectomies, for example, are possible for our patient.

I think in HCC, it’s so crucial and really important to make the diagnosis within a multidisciplinary tumor board. And this is not only the case when you start treatment but at each time point when you do the CT scans as follow-up scans to see how the treatment worked, and to decide how to proceed, you really need the tumor board. So if you do not have the opportunity to really discuss your patient along the way of treatment within a tumor board, I would really think you should not treat the patient. It’s really different from other tumors, and in my eyes, it’s because of the underlying liver disease, a little bit more complicated. And the hepatologist and gastroenterologist really need to be part of the team. So patients with HCC clearly should be treated in larger centers with experience in HCC.

Communication within the interdisciplinary tumor board is extremely important because we have all these different members of the different departments, and of course, everybody is trying to provide his treatment and is convinced that his treatment is the best treatment. But still, in most patients, only 1 or 2 treatments are really appropriate and the best choice for the patient. In the past year, I think we have really gotten used to communicating a lot and we have learned a lot. I think we all understand the possibilities each treatment can provide for our patients, and we are getting better to really see the specific opportunities where we can use one or the other treatment. So at the moment, I think it’s not really that difficult anymore to come up with the right decision. It’s really so dependent on tumor burden and liver function that, in most cases, we can really easily come to a decision.

Transcript Edited for Clarity

Brought to you in part by Eisai
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