Liver Cancer Surgery: Liver Cancer Surgeon in NYC
Dmitri Alden, MD performs more than 200+ liver and bile duct surgeries a year.
The top rated NYC liver cancer surgeon offers a multidisciplinary super specialized custom liver surgery program dedicated to the treatment of adults and children with all stages of liver disease including liver cancer. Dr. Alden provides comprehensive state-of-the-art customized services, including diagnostic testing, medical treatment, liver surgery, liver transplantation, and support prior and after treatment.
Dr. Alden runs a highly specialized state-of-the-art practice dedicated solely to cancer treatments ( liver, bile, ovarian, and pancreatic surgery). Dr. Alden has performed over 3500 surgeries in the past 14 years. Dr. Alden has been identified as America’s Top 100 Surgeons (Consumers Research Council of America) for his achievements as a specialist and is top rated by his patients for his “bedside manner”. Dr.Alden has extensive experience in traditional operations on the liver and pancreas and also separate extensive specialized training and experience in performing Laparoscopic and Robotic liver cancer and pancreatic cancer surgery of which the reward is quick healing and recovery, a short hospital stay, faster access to additional necessary treatment, and an excellent cosmetic outcome.
- Patients and medical professionals from America and around the world seek out Dr. Alden’s specialized best in class individualized liver cancer treatments and services including his expert surgical management of the patient’s unique condition.
- Patients referred to Dr. Alden have access to a vast array of specialists who are some of the best in their field in the country (and possibly in the world).
Liver Cancer Surgery: Hepatocellular Carcinoma (HCC) / Primary Liver Cancer – NYC Oncological Surgeon
Hepatocellular carcinoma (HCC) or primary liver cancer is a tumor that originates in the liver. Hepatocellular carcinoma (HCC) or primary liver cancer is not a metastasis that has spread into the liver from other sites. This tumor is a common complication of liver cirrhosis. The vast majority of patients with these tumors in the United States have hepatitis C or alcoholic cirrhosis, which is the main cause of their HCC / liver cancer. In contrast, in Southeast Asia hepatitis B is the most common cause of HCC.
It is very important for the NYC liver cancer surgeon to determine the cause of HCC / primary liver cancer in each patient because the tumor behaves very differently and has a different pattern of spread and complications depending on the underlying liver disease. HCC represents 95% of primary liver cancers and is one of the most common cancers. The incidence of HCC / liver cancer has more than doubled in the last 20 years and with aging “baby boomers” the rates of liver cancer will likely continue increase. Currently, 3.9 million people in the United States are infected with hepatitis C, and many of them will develop HCC.
Please note: Dr. Alden accepts insurance and additionally accepts full out of network insurance benefits (we will contact your insurance company and submit for you). You will enjoy the luxury and benefit of academic medicine in a top rated concierge environment without the hassle of long hospital waiting room times and paperwork. Most policies reimburse patients for most of the cost of surgery. Our surgical coordinator will help you with a quote.
Diagnosis of Hepatocellular Carcinoma (HCC) / Primary Liver Cancer
The diagnosis made by the world class liver cancer surgeon is usually made by imaging studies such as ultrasound, CT scan, or MRI, which will show a mass in the liver. Ultrasound is an excellent tool for initial liver cancer screening and detects 93% of HCC tumors. If ultrasound is performed routinely every 5-6 months by a skilled ultrasonographer, it will detect virtually any tumor up to 3 cm. CT scan or MRI done while “dye” contrast is traveling through the arteries of the liver will also show a tumor. Without dye contrast, it is very hard to distinguish this tumor from a normal liver. Both CT and MRI are helpful to make a diagnosis and are essential tools in planning the treatment.
Another extremely important tool in screening and follow-up of HCC is a tumor marker called alfa-fetoprotein (AFP). Anyone diagnosed with liver disease must have AFP levels checked on a regular basis. In patients with hepatitis C the AFP level can rise and fall from time to time, but an elevated level is immediate cause for an imaging study. HCC does not always produce elevated levels of AFP, but very high levels of AFP in a patient with alcoholic cirrhosis or hepatitis C almost always means the patient has HCC. Only 65% of HCCs in alcoholic cirrhosis and about 75% in hepatitis C show elevated AFP levels. In contrast, 93% of patients infected with both hepatitis B and C will have elevated AFP. HCC originating in a normal liver is extremely rare, and only 33% of such patients will have elevated AFP levels.
Treatment of Hepatocellular Carcinoma (HCC) / Primary Liver Cancer
The surgical oncological treatment for HCC / primary liver cancer is complex and requires a multispecialty approach. Management of the tumor has to be considered along with treatment of any underlying hepatitis C, cirrhosis, portal hypertension, ascites, or esophageal varices. The treatment includes liver resection, radio-frequency ablation, arterial embolization and chemoembolization, medical chemotherapy, and liver transplantation. Treatment decisions are commonly based on the number of tumors, their size, and location (whether they are concentrated in one lobe of the liver or both lobes).
Different opinions exist about what is better for HCC—liver resection or liver transplantation—and it is a subject of ongoing debate. Many factors such as status of the underlying liver disease play a role in the decision-making process. In the surgical liver transplant world, the “gold standard” for eligibility for liver transplantation is the “Milan criteria.” Using the Milan criteria, a patient is selected for transplantation when he or she has one tumor of 5 cm diameter or less, or 2 to 3 tumors of 3 cm diameter or less.
In the NYC liver cancer surgeon’s opinion, for HCC in a patient with good performance status, no ascites, and a good MELD score, liver resection is the treatment of choice. MELD stands for “Model for End-Stage Liver Disease,” and is a scoring system for assessing the severity of chronic liver disease.
Resection could be performed almost immediately after liver cancer diagnosis without the long waiting time for a liver transplant, thus avoiding the risk of liver disease progression. Among the patients with HCC who decide to wait for a liver transplant, the tumor progresses in 30%, and these patients may eventually become ineligible for either liver resection or transplantation.
What if liver resection is not possible? In this case minimally invasive laparoscopic radio-frequency ablation and arterial embolization or chemoembolization are great choices. Radio-frequency ablation destroys the tumor cells, and embolization cuts off the arterial blood supply to the tumor. I strongly believe that a combination of these two modalities offers great outcomes.
For more information regarding Liver Cancer Surgery: Hepatocellular Carcinoma (HCC) / Primary Liver Cancer or for a complimentary consultation with the liver cancer surgeon, please feel free to contact the NYC Liver, Pancreatic & Bile Duct Oncological Surgeon, Dmitri Alden, MD, FACS, today by phoning his NYC office (212) 434-6216 or emailing the surgeon directly using the eFom on the right.
Dmitri Alden, MD, FACS
Liver, Pancreatic & Bile Duct Oncological Surgeon
186 E 76th Street
New York, NY 10021