Liver and pancreatic Cancer

Liver and pancreatic Cancer

Athens Medical Group pioneers in the treatment of types of cancer that are difficult to treat, such as liver and pancreatic cancer. Our new, specialized clinics host a multidisciplinary team of doctors with surgical experience of hundreds of liver and pancreas surgery operations and ongoing clinical and scientific work.

AMG care team

Following the latest international guidelines and protocols, at Athens Medical Group we offer a holistic treatment of liver and pancreatic cancer through the collaboration of leading scientists that constitute the Oncology Board.

The Oncology Board is a multidisciplinary team of scientists, such as liver and pancreas surgeons, hepatologists, oncologists, radiation oncologists, interventional radiologists, gastroenterologists, pathologists and transplant specialists that use their collective knowledge, experience and expertise for the benefit of our patients.

If it is required, doctors and other health experts, such as, nurses specialized in working with cancer patients, dietitians and psychotherapists may also take part in the Oncology Board.

Your own personal care team of physicians and health specialists will work closely with you to understand your needs, review your therapy options and recommend a treatment and care plan tailored to your unique diagnosis.

At Athens Medical Group we have the resources to provide the most accurate diagnosis for the early treatment of liver and pancreatic cancer as well as the best possible outcomes, by implementing the most advanced approaches and following strict International Quality Protocols.

Our physicians are at the forefront of clinical care and research into the latest treatments for liver and pancreatic cancer offering a wide range of methods and innovative treatments, such as radiofrequency ablation, chemotherapy, radiation and biological therapy, as well as a variety of surgical operations, including liver transplant, with optimal results.

Departments that treat this condition:

Gastroenterology and Hepatology
General Surgery
Medical Oncology
Radiation Oncology

  • Liver Cancer

The suspicion of liver cancer can be put on various occasions. Most patients have chronic hepatitis and / or liver cirrhosis before developing cancer.

Generally, diagnosis of liver cancer is based on the following examinations:

Clinical examination: The doctor asks for symptoms and examines the abdomen and the rest of the body.

Blood tests: The blood test may reveal an increase in AFP, a so-called cancer marker, but this is only found in 50-75% of patients with liver cancer.

Radiological examination: At first, an ultrasound helps to assess the composition of the liver. In 75% of liver cancer cases, several nodules * (or tumors) are identified at various points.

A CT or MRI gives a more accurate picture and enables the detection of smaller nodules. Magnetic resonance imaging can be extremely useful in patients who already have (benign) nodules due to cirrhosis. These tests are sometimes performed with the use of intravenous infusion of a contrast fluid which identifies nodules.

The series of tests that are used to diagnose liver cancer depend on the level of damage and the presence of cirrhosis revealed by radiological examination.

Histological examination

It is performed on a liver tissue sample called a biopsy. The decision for a biopsy should be discussed with a number of experts, including a surgeon specialized in the liver surgery. It is the only way to assess whether the damage found in the radiological examination is either benign or malignant. A biopsy is performed with a needle that penetrates the liver and removes a liver tissue sample. Sometimes an ultrasound or CT scan is used at the same time in order to ensure that the needle is properly directed to a nodule that raises suspicions for cancer. A surgeon can also get a biopsy during an operation called laparoscopy. During laparoscopy, the surgeon inserts a small camera and fine tools through one or more small incisions to the abdominal skin to see the inside of the abdomen and get a biopsy without having to make a large incision in the abdomen. The tissue sample will be examined in the laboratory by a specialist called a pathologist. The latter can do various tests to determine the specific type and tumor characteristics. However, even if the pathologist does not diagnose the presence of cancer cells, one cannot rule out that the tumor is malignant.

A biopsy cannot be done in the following cases:

  • When the patient is extremely weak to undergo any treatment
  • When the patient has advanced cirrhosis and has been put on a waiting list for a liver transplant
  • The patient may undergo surgical removal of the entire tumor

The second histological examination is performed on the tumor and the lymph nodes removed with surgery. The pathologists identify the existence of a tumor and determine the type of the cancer, e.g. hepatocellular carcinoma, fibrous carcinoma, etc.


Physicians use staging to assess the extent of the disease and the prognosis of the patient. The stage is fundamental for deciding the proper treatment. The more advanced the stage, the worse the prognosis.

Different tests aim to ascertain how much the cancer has grown inside and outside the liver, and if it has already been spread to the rest of the body or not, something that can be assessed with the help of a CT scan or MRI of the abdomen.

If there is suspicion that the cancer has spread elsewhere, more tests may be performed in other parts of the body, such as a thorax CT scan and bone scintigraphs.

Staging is usually done twice: after clinical and radiological examination and after surgery. If surgery is performed, the removed tumor can be examined in the laboratory.

The results of the test can also help in the staging of the cancer.

Since most liver cancers are developed as a result of cirrhosis of the liver, both cancer and the underlying disease (if any) should be staged. Both determine the treatment options and the expected outcome. 

  • Pancreatic Cancer

Clinical examination: Clinical examination does not help much in the final diagnosis of cancer in the pancreas except for the cases where obvious symptoms are observed, such as jaundice.

Imaging testing: Ultrasound scanning is the first step in the diagnosis of pancreatic cancer, highlighting the bile and pancreatic duct.

A CT test gives information on the operability of the tumor. Magnetic resonance imaging is also used for the same purpose.

Endoscopy: Endoscopic retrograde and magnetic resonance cholangiopancreatography are performed in patients who do not show a clear mass.

Endoscopic ultrasound and laparoscopic surgery contribute both to the diagnosis and the staging of the disease when the latter is verified.

The planning of a suitable treatment requires the involvement and meeting of an interdisciplinary team of medical professionals and specialists, the so-called oncology board. Based on the available diagnostic data, the patient’s general state of health, the condition of the liver and pancreas, as well as various information on the tumor, the oncology board forms a treatment plan personalized to the needs and goals of the patient.

The risks of each type of treatment are also taken into account. The extent of treatment depends on the cancer stage and the risks involved.

All treatments listed have benefits, risks and side-effects. Your AMG care team of specialists along with your personal doctor will explain to you all the effects of each treatment and guide you to decide the treatment that is best suited for you.


  • Liver Cancer


The surgical removal (resection) of a tumor from the liver is the first line of treatment for hepatic malignancies.

Surgery for Liver cancer is very complicated. That is why it should be performed only by hepatobiliary surgeons with extensive experience, knowledge and expertise. Athens Medical Group is national a point of reference for both liver and pancreas surgery, with high success rates.

There are two categories of operations used to treat liver cancer:

Removal of the tumor. In these cases, the tumor is removed surgically along with a portion of healthy liver tissue that surrounds it.

Liver transplant. The liver is removed and replaced with a healthy one from a donor.


  • Laparoscopic and Robotic Surgery

Your team of physicians at Athens Medical Group may recommend minimally invasive (laparoscopic) surgery for your liver cancer, instead of the traditional, open surgery, depending on the location and size of the tumor.

Our surgeons are leaders in minimally invasive (laparoscopic) surgical liver resection.

Laparoscopic surgery for liver cancer offers many advantages for the patient, such as:

  • Easier identification of noble elements due to the magnification of the surgical field
  • Limited damage to healthy tissue
  • Less postoperative pain
  • Shorter hospital stay
  • Faster recovery and return to his everyday life
  • Excellent oncological results
  • Optimal cosmetic outcome thanks to smaller incisions and less scarring
  • Treatment of metastases

In the liver cancer, the presence of metastases, i.e. the spread of the tumor to other organs, namely the lungs, is an indication of advanced disease.

Developments in both medical science and technology now offer many possibilities for treating metastatic disease such as:

  • Surgical resection of metastases
  • Metabolic Dehydration (RF Ablation)
  • Embolism
  • Chemoembolization
  • Chemotherapy

AMG’s Da Vinci Si HD Single-Site robotic systems offers an alternative to traditional laparoscopy offering offers greater vision, precision, stability and control for the surgeon.

The ergonomic design of the da Vinci robotic system enables our highly specialized and experienced surgeons to operate from a comfortable, seated position at a console, enjoying significant advantages, such as:

  • Optimal surgical precision
  • Unparalleled range of motion
  • Improved dexterity
  • Enhanced visualization that cannot be matched by the naked eye
  • Increased access to areas that are difficult to reach


  • Radiation therapy

Radiation therapy involves the use of energy sources to kill or shrink cancer cells. For some patients, the radiation is used to shrink the tumor enough in order for it to become respectable.

Also, radiation therapy is carried out for palliative treatment.

Our radiation oncologists use advanced technology that allows them to target tumors that are difficult to reach and minimize the exposure of healthy tissue to radiation.


  • Interventional Radiology

The liver is an organ that displays either primary neoplasms (hepatocellular cholangioma) or metastatic neoplasms from primary foci of all organs, especially the gastrointestinal system.

Surgical treatment of metastases is not always possible, and systematic chemotherapy often does not have the expected response from liver metastases.

Invasive radiology in the liver and bile ducts is used for:

  • Liver biopsy – bile duct.
  • Irreversible Electroporation. This is a modern method for treating locally advanced pancreatic cancer without metastatic disease. In involves the use of an electric field produced by four electrons that destroys the cell membrane of the cancerous cells. The effect of cell death (apoptosis) makes systemic chemotherapy more effective and increases median survival in these patients.
  • Percutaneous ablation with radio frequency (RF) or microwaves (MW).
  • Ablation of liver metastases mainly from the large intestine, but also in general from all the primary foci.
  • Chemotherapy of primary or metastatic tumors.
  • Combination of chemotherapy with ablation for primary and metastatic tumors.
  • Bile ducts with stent placement.
  • Cholecystostomy in the case of bile duct obstruction and peritoneal inflammatory development.

Treatments are performed in two ways:

Intra-Arterial: By use of a micro-catheter on the digital angiogram, chemotherapeutic drugs are effused directly into the tumor in high concentrations and embolism (obstruction with microspheres) of the arteries that supply blood to the tumor is performed, leading gradually to the shrinkage and necrosis of the tumor.

Percutaneous: With the patient on the CT, a thin needle electrode is positioned in the tumor. This caused overheating (60-100 C) of the tumor within a few minutes (e.g. cauterization with radio frequency (RF) or microwaves (MW) of foci in the liver).

Thus interventional radiology treatments are applied in unresectable primary tumors of the liver (hepatocellular cancer, cholangiocarcinoma) or secondary tumors from other primary cancers, where conventional treatments do not have the desired response. They are always performed with the consent of the treating oncologist.

All of the above techniques are applied with great results. Hospitalization usually lasts one day and the patient returns to his home the following day.

The end result depends on many factors, such as the type of primary tumor, the number and size of the outbreaks of the tumor, its localization, the general health status of the patient, the possibility of repetition of chemo-embolism, and others.


In this treatment, microspheres that contain Iodine 131 or Yttrium-90 are placed directly in the liver with the aim of delivering radiation directly to the tumor.


  • Chemoembolization

The intra-arterial chemoembolization is a method that achieves the transfer of high concentrations of chemotherapeutic drugs directly to the tumor through a percutaneous, intra-arterial catheter, as well as the ischemia and necrosis of the tumor, through the embolization of its feeding arteries.

Intra-arterial chemoembolization is generally well tolerated and serious complications are extremely rare.

Our hospitals are visited for chemoembolization by patients with primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) or secondary liver metastases from other tumors (colorectal carcinoma, lung cancer, breast cancer, neuroendocrine tumors, kidney cancer, sarcoma, melanoma, soft tissue tumors, etc.).

an intra-arterial chemoembolization

Liver is susceptible to cancer metastases, through the blood tract, particularly of the gastrointestinal system. The surgical treatment of the tumors is not always feasible, while systemic chemotherapy doesn’t always generate the liver’s expected response.

In many of those cases, it is suggested to implement an intra-arterial chemoembolization, in order to address the secondary foci in the liver. This method has proved to generate very encouraging results.

Intra-arterial chemoembolization for liver metastases is frequently performed in the Interbalkan Medical Center, with the administration of chemotherapeutic agents which are well tolerated by patients.

Liver metastases may be derived from colon, lung, kidney, breast, pancreas, stomach, or ovarian cancer or from melanomas, sarcomas, neuroendocrine tumors, soft tissue tumors, etc.

Hospitalization usually lasts one day and then the patient may return home. The final result depends on many factors, including the type of the primary tumor, the number and size of tumor foci, its localization, the overall health of the patient, the repeatability of the chemoembolization etc.


  • Targeted drug therapy

Targeted therapy involves the use of special drugs that block the growth and spread of cancer cells while limiting damage to healthy cells. These drugs are sometimes used to treat secondary cancers in the liver. They may be used after or together with other types of cancer treatment.


  • Injection of ethanol into the tumor

This treatment involves the injection of ethanol (concentrated alcohol) through the skin, with a help of a needle, and directly into the tumor with the aim of burning it.


  • Pancreatic Cancer


Surgical removal of the tumor from the pancreas is the only therapeutic option, which can potentially lead to healing. However, less than 20% of the patients have a resectable tumor, something that is determined after radiological evaluation.

The treatment of pancreatic cancer is a complex problem due to the delayed diagnosis, the need for specialised surgery and the large number of relapses.

Decisions on tumor therapies and tumor removal should, according to the international guidelines, be obtained by surgeons specialised in pancreatic surgery, who have demonstrated the appropriate experience and have high rates of successful tumor resection, even in cases previously thought to be inoperable.

Chemotherapy therapy

Chemotherapy uses drugs that are either injected into a vein or taken orally and help destroy cancer cells.

Chemotherapy may be combined with radiation therapy for treating pancreatic cancer that has spread to nearby organs, before surgery to help shrink the tumor or after surgery to reduce the risk of a relapse.

Chemotherapy is often used to patients with advanced pancreatic cancer as a means of delaying its growth and thus prolonging survival.


  • Radiation therapy

Radiation therapy involves the use of energy sources to destroy cancer cells. Also, it is used to shrink tumors before surgery and to relieve symptoms of cancer that has metastasized.

Some of the most frequent questions asked to our doctors include:

  • Where is the location of the cancer?
  • What is the type and stage of my cancer?
  • Has my liver cancer metastasized?
  • What kind of tests will I need?
  • What are my treatment options?
  • Can my cancer be cured? What are the chances?
  • How much does each treatment increase my chances for cure of my cancer?
  • What are the potential side effects of each treatment?
  • How will my daily life be affected by each treatment?
  • Which treatment do you believe is best for me?
  • How soon must I decide about the type of my treatment?
  • Would it help to seek a second opinion?
  • Would it help to see a specialist? What will be the cost of that? Will my insurance cover it?
  • Is there any printed material that I can take with me? Where can I find more information online?
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