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Liver Cancer: Requires a Multidisciplinary Plan

Dr. Lynt B. Johnson discusses liver cancer, its causes and treatment options for those afflicted with the disease.
Liver Cancer: Requires a Multidisciplinary Plan
Lynt B. Johnson, MD, MBA
Lynt B. Johnson, MD, MBA is the Executive Director, Liver and Pancreas Institute for Quality and is affiliated with The George Washington University Hospital.

Learn more about Lynt B. Johnson, MD, MBA

Dr. Mike Smith (Host):  Liver cancer requires a multi-disciplinary plan, and the George Washington University Hospital and affiliated clinics understands this and practices it. Welcome The GW HealthCast. I'm Dr. Mike Smith, and today's topic is the multi-disciplinary planning for liver cancer. My guest is Dr. Lynt Johnson. He's Professor of Surgery and Executive Director of the Liver and Pancreas Institute for Quality and is affiliated with The George Washington University Hospital. Dr. Johnson, welcome to the show.

Dr. Lynt Johnson, MD, MBA (Guest): Good morning. Thank you for having me.

Host:  So let's start off, how about with a nice review of liver cancer; the different types, how common it is, risk factors. Why don't you run us through some of that?

Dr. Johnson:  Sure, Dr. Smith. So liver cancer really comes in two distinct populations. The most common form of liver cancer is really secondary liver cancer that has spread from another site, and in particular colon cancer, 50% of patients with colon cancer will develop liver cancer sometime during their lifetime. The other type of liver cancer is primary liver cancer which occurs primarily in patients who have chronic liver disease; either hepatitis B, hepatitis C, and most recently the most common liver disease in the country, which is fatty liver disease. And these are patients who developed cancer in the liver primarily without spread from another site.

Host:  Yeah. Let's talk a little bit more, Dr. Johnson, about the secondary form of liver cancer. You mentioned about up to 50% of colon cancer patients will have the cancer spread to the liver. Have we learned why that happens? Are there risk factors that have been identified? Are there colon cancer patients that you're more worried about when it comes to the secondary liver cancer?

Dr. Johnson:  Sure. Generally patients who have tumors that have spread to the lymph nodes and are more invasive have a higher risk of developing tumors in their liver, and primarily it is because the blood supply of the colon drains directly into the liver, so any cells that are released from the primary tumor can get into the bloodstream and then end up setting route into the liver itself.

Host:  And so when you are faced with this challenge of secondary liver cancer, are there some new innovations on the horizon for treating these patients? Are we improving outcomes in these patients today? Tell us a little bit about that.

Dr. Johnson:  The outcomes over the last two decades have almost doubled in terms of the overall five-year survival of patients who develop liver cancer from their primary colon cancer, and much of this has been because of the multi-disciplinary approach to the underlying disease. Most of these patients are primarily under the care of a medical oncologist, and they receive chemotherapy or targeted therapy for their colon cancer either right after surgery or when they develop initially the tumors in the liver. And while there have been significant advances in medical care with these drugs, surgery still remains the main option for cure, and cure can be provided in up to about a half of these patients who present was spread from their colon into the liver with surgery.

Host:  Let's move the conversation a little bit into something that I think- well, I know I would like my audience to know about this, because I think it's really important. And the George Washington Hospital System definitely, in my opinion, is a leader in a multi-disciplinary approach to many disease processes, but specifically with cancer. Tell us a little bit about how important it is to have this team approach, and what do we mean by that? Who is actually involved in taking care of liver cancer patients, or just cancer patients in general at GW Hospital?

Dr. Johnson:  So you're exactly right, and there's no question that the multi-disciplinary care approach improves care for patients. We have a weekly multi-disciplinary tumor board where we review patients and their critical status along with their abdominal imaging to formulate a plan for patients that may include a combination of chemotherapy, radiation therapy, sometimes ablative therapy where the radiologist injects either radiation or chemotherapy into the tumors, and then also obviously surgery.

In addition to those groups, we also have radiologists that interpret the images, as well as pathologists that review the biopsies from these individuals in order to come to a consensus- agreement as to what's the best approach for each individual patient.

Host:  And you did mention that it improves outcomes, right? And that's really the goal of all of this, right? No matter what we're dealing with in medicine, we want the outcome for the patient to be better. Do you see more and more larger medical centers following this type of team approach? Or is this something that's still relatively new, but needs to be initiated at centers?

Dr. Johnson:  I think that there are varying forms of this type of approach that different centers have, and in my opinion, the more coordinated the care is, and the more tightly knit the group is in terms of their overall efforts for patients, is the optimal situation. And you know, I think that here at George Washington, we've really put together a group of specialists who all have a focus and concentrated interest in patients with gastrointestinal cancers, and therefore can provide what I think is state-of-the-art and a very innovative care for each individual patient.

Host:  Dr. Johnson, it's listed here that you are the Executive Director of the Liver and Pancreas Institute for Quality. I actually went to the website and I learned a lot about the multi-disciplinary approach that you lead at the George Washington University Hospital System. Tell us a little bit about what this institute is- this institute for quality. What are the goals? What's the mission? And how has it gone so far?

Dr. Johnson:  Thank you. You know, I was recruited here to George Washington after a fairly long career, about twenty to twenty-five years invested in patients who have liver and pancreas diseases. And one of the things that struck me most is that we really are focused a lot on how many patients that we care for, not necessarily how well our patients do. And really from a business perspective, quality really means outcome over divided by cost. And so if we can improve our outcome, and really provide efficiency of care to patients by having this coordinated group of individuals who focus on individual patients, and reduce overall complications, and get patients in and out of the hospital in a streamlined fashion. That's really what we focus on in terms of providing quality to our patients, and providing the best outcome at the lowest expense that we can.

Host:  Makes a lot of sense, right? But I don't know- again, back to the idea of larger medical centers throughout the United States, I don't know of too many that have a dedicated institute for quality like George Washington University Hospital does, so I think that's a wonderful thing, and I thank you for the work that you're doing in terms of quality. I think it is, as you say, very important.

You know, let's end this with two questions. The first one- and they're both kind of the same, so let me just get both questions out, and I'll let you run with it, Dr. Johnson. The first question is what would you like people to know about liver cancer, and specifically secondary liver cancer? And then, what would you like them also to know about the importance of teamwork?

Dr. Johnson:  Sure. So the first thing- and most patients that I see in the office, they're very surprised, and the first thing they say to me is, "Well, I don't have any symptoms. I feel fine." And in reality, most of our patients who present with liver cancer will not have symptoms. So the lack of symptoms does not mean that you do not have a serious underlying condition, and therefore because of that, patients who have a history of colon cancer, or really any abdominal cancer, must maintain follow-up with their physician in order to try to detect any evidence that will spread at a very early stage. And the earlier that we are able to diagnose this, the much better the outcomes are from the standpoint of being able to offer a cure to many patients who have the secondary liver cancer, which in many underlying cancers when it spreads to a different site, it is stage four, and most of these patients go on to die from their disease, which is not true for patients who have spread from colon cancer.

And so I think that the take-home message is be vigilant about your follow-up in your care if you're given a diagnosis of primary cancer so that we can make sure that if any additional areas of spread occur, we can detect those and treat those at an early stage. That really is the key to having the best outcome.

As far as the team approach, I really believe that being taken care of in these complex medical conditions in a silo where you have one physician who's dealing with one problem, and they're really not communicating with other physicians who ultimately also provide a different approach to the treatment of a patient, can really sacrifice the optimal care that we're able to offer. And therefore it is very hard nowadays with so much medical information available for everybody to be an expert in every discipline, and so the importance is we bring these specialists together, each one of them being an expert in their own discipline, but it allows them to also collaborate with other folks who ultimately are at the top of their game as well, and therefore it provides a better atmosphere.

It's almost like a football team. You have a head coach but you also have an offensive coordinator, a defense coordinator, a special teams coordinator, and each one of those individuals are bringing different expertise to the overall game plan so that you can win the game, and that's ultimately what we're trying to do here.

Host:  Right. Great analogy. You know, Dr. Johnson, I want to thank you for the work that you are doing, and also thank you for coming on the show today. You're listening to the GW Healthcast. Please visit to get connected with Dr. Johnson or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.. I'm Dr. Mike Smith, thanks for listening.