Multidisciplinary management of tumors of the liver and bile ducts
Moderators: David Linehan and Betsy Tuttle-Newhall

• ERCP: is it really needed and if yes, when to perform, by whom, and where
• Transaxial imaging : when should it be performed and what kind of imaging is appropriate
• Multi-disciplinary evaluation and management
• Tissue diagnosis of cholangiocarcinoma: how to obtain tissue, what are the acceptable gold standards
• Patients with PSC: when to suspect cancer and how to diagnose it

• Role of tissue diagnosis in patients with suspected HCC
• potential benefits
• whom
• how
• Screening and surveillance for HCC
• tumor staging
• co-morbidities
• Treatment considerations in patients with suspected HCC

• CT vs MRCP
• which one to choose for HCC vs. cholangioCA
• what special protocols to use for liver tumors
• Role of PET and Duplex US in these patients
• Evaluating resectablity in hilar cholangioCA
• Diagnostic accuracy of radiologic imaging for cholangioCA and HCC

• Resection vs. transplantation
• Which patients are eligible for transplantation
• How to determine resectability for hilar and intrahepatic cholangioCA
• What to do if tissue diagnosis of cholangioCA cannot be established
• Outcomes of surgery for cholangioCA
• Malignant masquerades:  how they are dealt with surgically and their outcomes

• Patient selection: expanding Milan criteria
• Patients with hepatitis B vs. hepatitis C
• Bridging therapies
• transarterial chemo-embolization
• percutaneous ethanol injection
•  Patient selection for definitive therapy
• Role in down staging HCC
• Combination therapy
• RFA
• radiation
• systemic therapy

• What clinical presentations should prompt small bowel imaging for tumors
• How to choose between capsule endoscopy and DBE
• Common tumors noted in small bowel by CE and DBE
• What if both CE and DBE are negative?  Should CT or MR enterography be performed
• Mass lesions seen on CE: how to further manage these patients?

• Available radiologic imaging tests for patients suspected small bowel tumors
• Indications for using small bowel imaging
• Radiologic findings for the different small bowel tumors
• Radiation risk to patients undergoing these evaluations

• Common clinical presentations of small bowel tumors presenting to a surgeon
• Appropriate pre-operative work-up in a patient with small bowel tumor noted on imaging is a tissue diagnosis necessary
• What are the different surgical procedures for the different small bowel tumors
• Expected outcomes in patient s with small bowel tumors
• How to follow up these patients after surgery

• What transaxial imaging to perform prior to ERCP
• What to do if no mass is identifiable on CT/MRI
• Role of EUS-FNA  in these patients
• Staging of pancreatic cancers: role of EUS
• ERCP for biliary drainage : how to decide who would benefit

• Common pitfalls in management prior to surgical consultation for pancreatic cancer
• Value of EUS-FNA in patients with obstructive jaundice
• and mass lesion on CT scan
• no identifiable mass lesion on CT scan
• Non-jaundiced patient with potentially resectable mass in body of pancreas
• should tissue diagnosis be obtained prior to surgery
• What is appropriate staging work-up for patient with pancreatic cancer

• What is comparative survival in pancreatic cancer patients with R0, R1 and R2 resection and how does it compare with patients who elect not have surgery
• How accurate is the radiologic imaging for staging pancreatic cancer
• do R1 and R2 resections occur only in patients with borderline resectable tumor on CT/MRI
• Borderline resectable tumors
• how to define them
• should they always receive pre-operative chemoradiation
• Unresectable pancreatic tumors in younger individuals- Is aggressive therapy worth it for the patient

Health care reforms:  Physician’s perspective – John Matthew Inadomi, M.D.
Health care reforms: Hospital’s perspective - David Applington
Health care reforms: How it is likely to affect private practice - John Allen

• Degree of dyplasia and risk of cancer
• Are there molecular markers that are associated with increased risk of cancer
• Does presence of severe GE reflux increase the risk of Barrett’s associated cancer
• Barrett’s Surveillance: is it worth the cost
• What are optimal intervals between endoscopy for Barrett’s surveillance
• Barrett’s with dysplasia on biopsy
• should be biopsies always be reviewed by a second pathologist
• what if the pathologists differ in their interpretation of dysplasia
• Barrett’s with high grade dysplasia in the background of inflammation
• when should the biopsies be repeated
• what if the inflammation does not resolve on repeat biopsies

• Role of PPIs: what is the benefit, what is the supporting data
• Role of ASA: what is the benefit, what is the supporting data
• Do they reduce cancer risk and by how much
• Who should be treated

• What are the current indications for surgery in patients with Barrett’s esophagus
• What are the various kinds of esophageal surgeries performed in these patients and what are their relative advantages and disadvantages
• What is the risk of post-operative complications
• What is the expected quality of life after esophagectomy

• Indications for Radiofrequency ablation for Barrett’s esophagus
• What are the potential complications of RFA
• What is achieved by ablation of Barrett’s by RFA
• does the cancer risk decrease
• do the patients still need to be on surveillance
• Potential role of Cryoablation for Barrett’s treatment - how does it compare with RFA