Scott Webb (Host): Today, I'm speaking with Dr. Joshua Kays, a board-certified surgeon in Surgical Oncology and Hepatobiliary Surgery, practicing at Franciscan Health, about the diagnosis and treatment of liver tumors, including some mind-blowing potential treatment options in the future.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about liver tumors, right? So, the causes, symptoms, treatment. So, let's start there. What are the primary causes and risk factors for developing liver tumors?

Dr. Joshua Kays: Yeah. So when I think liver tumors, and we talk about liver tumors, we really have to break them down into two main categories. We have primary liver tumors, and these are the ones that start in the liver. The main two of these are going to be called hepatocellular carcinoma, which is a tumor that starts from the actual liver cells or intrahepatic cholangiocarcinoma, which are tumors that come from the bile ducts within the livers. Then, you have secondary liver tumors. These actually are tumors that start other places and spread to the liver. Examples of these would be breast cancer, pancreatic cancer, stomach cancer, or colorectal cancers among many others that actually can spread and metastasize to the liver.

Host: Okay. So, some sort of originate in the liver, some spread to the liver. And I want to get a sense in terms of diagnosis, I hear from a lot of experts that sometimes we're looking for something else or we're looking at something else, we go, "Oh wow, we see something here in your liver." So, just give us a sense, like, how do you diagnose liver tumors?

Dr. Joshua Kays: Yeah, that's often the case. So, if you start with secondary liver tumors, part of the workup of many cancers is actually imaging the liver because we know that they like to spread to the liver. So, we find a lot of it in our colon cancers or breast cancers, because we're actually looking for them and trying to make sure that the tumor hasn't spread.

When you're talking about primary liver tumors, oftentimes someone comes in for a scan for some unrelated reason. You know, maybe, unfortunately, they were in a car accident or maybe they were just having some vague abdominal pain. So, they get a CAT scan or an MRI or an ultrasound, and lo and behold, we end up finding one of these.

Host: Yeah. I've heard that and I guess it's better to be lucky than good, maybe sometimes. So, you know, you're looking for something else and then you discover the liver tumor. And I just want to understand, you know, you said the sort of vague abdominal pain might be one of the symptoms for some folks. But what are the common symptoms? Like, do folks know that they have a problem with their liver? Do they know they have liver tumors or is it generally pretty vague?

Dr. Joshua Kays: Generally, it's pretty vague. Some people do know. So, one of the biggest risk factors for your primary liver tumors is cirrhosis of the liver. And the patients who have known cirrhosis should be getting screening. So, that consists of an ultrasound every six months where we actually look at the liver, because we know they're at high risk for developing these.

But again, as you just said, a lot of people just kind of-- they don't know this is going on. The symptoms are very vague. You know, when you talk, oh, they can have abdominal pain, they can have weight loss, they can have decreased appetite. The list of things that can cause that is extensive, and a lot of things that are a lot more common than a liver tumor.

Host: Yeah. And I just did a podcast recently on fatty liver disease, which of course would be a different podcast, but heard from that expert that fatty liver disease is now maybe in the lead in terms of causing cirrhosis. But again, another podcast for another day. Let's talk about treatment options and how do you decide which is best for a patient?

Dr. Joshua Kays: Yeah. This is actually a fairly complex decision process. First and foremost is what is the patient's underlying liver function? So in a person who has normal healthy liver, we basically have all of our tools that we can use, and we have a lot of them. But in someone that has cirrhosis or has a liver that's not functioning well, a lot of times that limits what we can do specifically, you know, how much of the liver we can cut out. So, it comes down to what is the underlying liver function, what is the patient's overall health?

And then, other things are what is the size of the tumor? Where is it located within the liver? And then, another big one is what is the underlying disease? If it's a primary liver tumor like hepatocellular carcinoma, that might need one treatment. Whereas if it's spread from somewhere else, maybe another treatment could be, you know, the best thing to do.

Host: Yeah. When we think about surgery, and I know we're speaking sort of broadly, kind of like headlines here today, but as best you can, give us a sense, you know, if you're going to be taking out liver tumors surgically, what does that process involve?

Dr. Joshua Kays: Yeah. So, the liver's actually a fairly large organ in the body. And there are some liver tumors that we can actually take out laparoscopically. Again, this all goes down to where is it located and how big is it. So if we can do it that, we can do it with all small incisions. Typically, you come in that day, you get watched overnight. And a lot of times, you get discharged the next day. But if it's a bigger tumor or in a tougher location to get to, it's going to involve an open incision where we actually have to make a fairly good sized cut to access the entire liver. And then, usually, that is going to be accompanied with about a five to seven-day hospital stay.

Host: Okay. Yeah, and like I said, we're just kind of speaking broadly here. It's patient by patient, case by case, liver by liver, if you will. What's the prognosis for patients with liver tumors?

Dr. Joshua Kays: Again, I keep coming back to the, it depends on the underlying, you know, disease. Because if it's hepatocellular carcinoma, most of these are going to be cancers, liver tumors. And as with every cancer, it's all about what stage you are. Stage is, probably, you know, the biggest role in what your outcome's going to be.

If we catch cancers early, many of them are treatable and some even curable. Whereas if we catch them late, a lot of times there's nothing we can do. If we catch things early, you know, very good outcomes after liver surgery. There's a few exceptions to that. Colorectal tumors, we've actually gotten very good at treating and have some chemotherapy that works really well. So, you know, take a patient who has a colorectal metastasis to the liver that's technically stage IV, end-stage cancer, but even with treatment, these patients, 50% of them are still alive or more at five years. So depending on, again, what the underlying problem is, we can have some very good outcomes.

Host: Right. Yeah. So as you say, staging is key. Early diagnosis, early treatment, and wondering what we can do, right? Like if we know, especially if we know we have the risk factors, whether it's family history, genetics, other things like diabetes or high cholesterol, whatever it might be, the greatest hits if you will, what kind of lifestyle changes can we make to help reduce our risk for liver tumors?

Dr. Joshua Kays: Yeah. So, I think you hit the first one on the head perfectly. If you know you have risk factors, you get your screening. If you have a family history of breast cancer or if you know you're the appropriate age, colonoscopy, mammograms, all of that. Catching these things early before they get to the liver is key.

As far as for your primary liver tumors, you know, I think the biggest things you can do, you already touched on it, fatty liver disease, if it's not the number one cause of cirrhosis in the U.S., it's neck and neck with alcohol. Eating healthy, staying a active lifestyle. If you're overweight, get whatever help you can. There's a lot of new things we, you know, for weight loss. Avoiding alcohol and smoking. Those are probably the other two biggest risk factor for your primary liver tumors and, you know, kind of tumors and cancers in general. So, avoiding smoking, alcohol, those kind of things. Those are going to be the best things you can do to decrease your risk as much as you can.

Host: Sure. Do you have any dietary recommendations? I hear a lot about the Mediterranean diet. And I think I have a sense from speaking with enough experts and where to shop in the grocery store to get the best things, the unprocessed things. But in general, what kind of dietary recommendations do you have?

Dr. Joshua Kays: That would be another whole podcast in itself. So, you know, just briefly, trying to stay away from processed things. Eat, you know, what I like to think of is real food, not the super processed foods that unfortunately are becoming more and more common in our diet. Stick to your lean meats, stick to your vegetables, your fruits, those kind of things as opposed to all the processed stuff that you know. Unfortunately, it's too easy to grab these days.

Host: Yeah, it is. As you say, we could do an entirely separate podcast on just how to eat right and shop right and all that. And I want to get a sense from you, you know, for patients who've been diagnosed and are going through treatment, what advice do you have for them and their families as they just try to cope with this?

Dr. Joshua Kays: Yeah. So, one thing I always tell people is, and I think most people know this, the liver actually has an incredible capability to regenerate itself. And what that allows us to do is-- we really have a lot of different treatments options because of that ability of the liver. So, I always tell them two things.

One is stay positive because, I mean, there's new stuff coming out all the time. There's new breakthroughs. You never know when a new study or a new drug or a new treatment's going to come out, that just totally changes what we're trying to treat. The other thing I tell them is I give them permission to have their bad days. I say, "Hey, this is not easy, and you're going to have bad days. And on those days you're going to have one job, and that's to get through the day and know that then tomorrow's hopefully going to be a better day."

So, those are really the two things that I kind of try to hammer home when I meet with patients and tell them to keep in mind is, you know, keep hope. And just on the days where it seems like the world's ending, just get through that day and then take on the next day.

Host: We'll see what tomorrow brings. Of course. Yeah. You mentioned there-- I just want to finish up-- you talked about the sort of new and exciting things and how fast medicine and science and technology and AI and all this stuff happening. Maybe you could just give us a sense, like what are you excited about, some of the advancements you're hearing about or maybe participating in when we think about liver tumor treatment.

Dr. Joshua Kays: Yeah. I think, you know, the biggest one is probably the immunotherapies, and this is going to go for all cancers. For people who aren't familiar, I'll give you a very brief summary. Chemotherapy is using chemicals, to kill cells. Immunotherapy is kind of unleashing our immune system to attack the cancer cells. And I think it's definitely going to be the future of how we treat a lot of cancers systemically, meaning, you know, where it's going to instead of chemotherapy, I think eventually we're going to be using immunotherapy to kind of treat a lot of things.

The other specifically related to liver is there's kind of a new technology that's using ultrasound waves to basically melt tumors. It's a very new thing that isn't even widely available right now. It's only gotten through proof of concept that, hey, we can actually use ultrasound to melt liver tumors. So, we're really exploring how to use this and what the outcomes are going to be right now. But I think that holds great potential for a lot of patients with liver tumors.

Host: Yeah, it's really amazing. You can't see me, listeners can't see me, doctor, but just often on this end of the conversations that I have with experts from Franciscan Health and other hospitals, just kind shaking my head, you know? Oh, melting tumors. I mean, who even thinks of that? But, that's the great thing I think from my perspective, and I hope for listeners, offering them some hope and optimism is that, you know, we may not have what you need today, but it might be tomorrow or the next day. And it just is so exciting to have experts like yourself on to explain all this to us and give us hope, give us reason to believe that folks can survive liver tumors and other cancers. So, I just appreciate your time. Thank you so much.

Dr. Joshua Kays: Absolutely. Thank you for having me.

Host: And to learn more, visit franciscanhealth.org and search liver cancer. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.