Center for Advanced Minimally Invasive Liver Oncologic Therapy
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Center for Advanced Minimally Invasive Liver Oncologic Therapy (CAMILOT) is a first-of-its-kind organization in the Pacific Northwest dedicated to treating patients with liver cancers using the most advanced and least invasive approaches. The Center brings together experts across multiple disciplines to develop, refine and deliver treatments to eradicate liver cancers while preserving liver function and patients’ overall health. Our principal objective is to effectively treat primary and secondary liver cancers using minimally invasive cutting-edge techniques, to accelerate patients’ recovery and to enhance their longevity and well-being. Traditional therapies often required protracted in-hospital recovery; we strive to reduce the hospital stay to a minimum, and often deliver therapies as outpatient procedures.
CAMILOT represents the ‘therapeutic’ arm of our long-standing
Liver Tumor Clinic at the University of Washington. The Clinic was established in 1998 and currently serves nearly 600 new visits annually, making it one of the busiest multidisciplinary clinics devoted to the treatment of liver tumors in the country. As the only university-based academic center in the Puget Sound area, the Liver Tumor Clinic has been pivotal in the introduction of novel treatments such as thermal and non-thermal ablations, minimally invasive liver surgery, catheter-based radiation therapy and external beam proton therapy, in addition to many clinical trials. Over the years, we have modified and advanced many of the procedures so that they can be safely delivered with the least amount of stress to the patient’s body, therefore minimizing suffering, reducing time spent in the hospital, enhancing recovery at home and returning patients to quality and meaningful living. In the past year, approximately 80% of more than 400 treatments delivered for liver cancers were performed using minimally invasive procedures at the University of Washington Medical Center. CAMILOT was created to meet the increasing demand for effective minimally invasive cancer care.
Since its inception, the Liver Tumor Clinic has served thousands of patients, the highest in the Pacific Northwest region. We have delivered the following treatments in the last year:
Volume of Partial Liver Resections (50.22) in Washington State
CAMILOT leverages the expertise and experience of clinicians and scientists to launch a vibrant and cohesive environment for innovation, investigation and delivery of the optimal clinical solutions for patients with liver cancers. The mission of this Center is to:
- Support innovation through scientific research and
- Provide an integrative solution that focuses on ‘value'
- Coordinate complex clinical care seamlessly
- Disseminate reliable information and formal education to healthcare professionals and the general public
The Center finds solutions for patients suffering from any form of liver cancer, with special emphasis on those with complex disease including unresectable or borderline resectable tumors and treatment-refractory cancers. Our patients can expect to receive a comprehensive evaluation and treatment plan, and referring providers will receive timely communication from member(s) of our team with our recommendations to jointly care for the patients.
We offer the latest in minimally invasive approaches including robotic and laparoscopic surgeries, ablations, catheter-based treatments, radiation and systemic therapies. In addition, the Center actively engages in research (clinical and basic) to advance our knowledge and to investigate new approaches to control, eliminate and prevent cancers.
There are two main categories of liver cancers: Primary and Secondary.
Primary liver cancers are malignant tumors that start in the liver. Hepatocytes and cholangiocytes are the two most common types of cells found in the liver. Hepatocytes represent approximately 75% of the liver mass, and these cells perform critical functions of the liver including the synthesis of many proteins, bile salts and cholesterol, among others. They are also responsible for detoxifying and excreting many products, including drugs. Once the primary bile is made by hepatocytes, it is transported through an extensive network of bile ducts similar to the branches and trunk of a tree. Cholangiocytes are the cells that line the entire biliary system and are critical to bile secretion by modifying its pH and electrolyte content to help with digestion once it enters into the intestine.
Not surprisingly, when the liver is injured repeatedly, cells can transform to become cancers by acquiring deleterious changes to their DNA. The most common causes of chronic liver damage are hepatitis C, hepatitis B, alcohol and metabolic diseases. These conditions predispose the liver to form cancers that resemble hepatocytes, so-called hepatocellular carcinoma (HCC), or cholangiocytes, known as cholangiocarcinoma (CC). In addition, any cause of persistent inflammation of the bile ducts also leads to CC. Together, HCC and CC represent more than 90% of all primary liver cancers. Importantly, they are increasingly common in United States and represent one of the most frequent causes of cancer-related deaths worldwide. Anyone with a history of long-standing liver disease should talk to their physicians for further guidance. Unlike most cancers, HCC is often diagnosed without the need for tissue biopsy, but rather by relying on good quality imaging using contrast CT and MRI scans. Upon diagnosis, a patient is best served by a multidisciplinary assessment by a team of experts including hepatologists, surgeons, radiologists, pathologists, medical and radiation oncologists to come up with a treatment strategy that is most appropriate for the individual.
Secondary liver cancers are malignant tumors that begin somewhere outside of the liver but have spread to the liver – also known as liver metastases. The rich environment of the liver supports the growth of many different cancers, and as a result, it is a very common place for cancers to propagate. These cancers are classified based on their sites of origin, and their behavior often resembles that of the primary cancer. Unlike hepatocellular carcinoma, a biopsy is often necessary to make an accurate diagnosis. Metastasis implies that the cancer cells have moved beyond the primary location into other parts of the body. Therefore systemic therapy--such as chemotherapy, targeted therapy and immunotherapy--is the cornerstone of treatment for secondary liver cancers. However, in many cases where the metastatic disease is predominantly confined to the liver, additional liver-directed therapies can improve disease control and survival in selected cases.
The most common form of secondary liver cancers is colorectal carcinoma. At least half of the patients with colorectal cancer will develop liver metastases either at the time of diagnosis (i.e. synchronous) or during their follow-up (i.e. metachronous). When treated optimally with systemic and liver-directed therapies, over half of the patients with metastatic disease to the liver will enjoy long-term survival (e.g. ≥5 years). Good preparatory planning and execution by a multidisciplinary team is the foundation necessary to achieve the best outcome. For example, in selected patients with synchronous metastatic rectal cancer involving the liver, careful planning with up-front chemotherapy and pelvic radiation can be followed by a one-stage combination minimally invasive surgery to take care of the rectal and liver disease.
Meet our Team
Raymond S.W. Yeung, M.D.
James O. Park, M.D.
Smith Apisarnthanarax, M.D.
Sharon W. Kwan, M.D.
Guy E. Johnson, M.D.
Wayne L. Monsky, M.D.
Sandeep Vaidya, M.D.
William P. Harris, M.D.
Supriya Saha, M.D.