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For Ricardo Bello, MD, MPH, a surgical oncologist at VCU Massey Comprehensive Cancer Center who specializes in the treatment of gastrointestinal cancers, including those that affect the liver, bile duct and pancreas, the ability to make a significant difference in patients’ lives is a driving force every day.

“In surgery, when you’re able to bring someone into the operating room and fix something, that’s a great feeling,” Bello said. “Using data and science, there is so much we can do to increase the likelihood of a good outcome for patients, and that really fits my personality.”

Bello earned a master’s degree in public health at the London School of Hygiene and Tropical Medicine after receiving his medical degree in Venezuela, where he was born and raised. He began his residency at Johns Hopkins University and finished it at the University of Massachusetts. Bello then completed a dual fellowship in surgical oncology and hepato-pancreato-biliary surgery — surgical procedures involving the liver, pancreas, gallbladder and bile duct — at the Medical College of Wisconsin. Always drawn to the concept of using his expertise to solve medical problems, Bello was recruited to Massey specifically to bolster the cancer center’s liver care program.

For Liver Cancer Awareness Month, we spoke with Bello to learn more about the disease, available screening and treatment options, risk factors, and more.

What is liver cancer?

The term ‘liver cancer’ can be misleading because most cancers in the liver don’t start in the liver. I like to classify liver cancer into two categories: primary liver cancer and secondary metastatic disease in the liver. Primary liver cancer, which originates in the liver, is much rarer. Of all cancer types, it ranks 13^th among the most common cancers, according to the National Cancer Institute. 90% of cancers in the liver are coming from somewhere else, often the colon.

Are there any symptoms?

Once symptoms happen, they’re usually non-specific and late in the disease stage. It can be abdominal pain, jaundice, dark urine and pale stool. Hopefully by this point, people have access to someone who can make a diagnosis or get the right imaging to identify if there is an issue in the liver. It’s always better to have an early diagnosis before any symptoms occur. That’s why there is such an emphasis on screening.

What screenings are available?

Everyone should have their colorectal cancer screening up to date because that can sometimes find cancers before they spread to the liver. Patients can schedule appointments for a colonoscopy at multiple VCU Health locations, now including its Stony Point clinic as well. People who are at an increased risk of hepatocellular carcinoma due to a history of cirrhosis or chronic hepatitis should be getting ultrasounds, as recommended by the American Association for the Study of Liver Diseases, and seek care with our excellent liver transplant surgery colleagues if there is a diagnosis of hepatocellular carcinoma. If you find cancers in the liver early, you can often still aim for a cure.

Treatment

We’re better at treating liver cancer than ever before. Mortality has decreased, treatments have improved, and there are more options.

For patients in which we know it is feasible, surgery is often the best option as a local treatment. In selected patients, this may include surgical transplantation. The liver is an incredible organ, but it requires careful planning and respect to safely operate on.

A significant percentage of colorectal tumors spread to the liver. That’s still treatable, but it makes care more complex. It becomes a case-by-case and nuanced decision whether to operate through surgery, administer targeted therapies in collaboration with VCU Health Vascular and Interventional Radiology, or to explore other treatment options through radiation, chemotherapy or immunotherapy. Cancers in the liver end up being a big group of very different diseases based on the individual patient. For every person, we’re understanding more and more that, depending on the mutations in each of their tumors, their treatment should be personalized.

What are the benefits of multidisciplinary care?

Massey is one of the best places offering patients multidisciplinary cancer care, specifically when it comes to more complex treatment options. We make most decisions about liver care in multidisciplinary environments. I tell patients it’s like getting a second opinion and a third opinion and a 10^th opinion all at the same time. Specialists have different perspectives and different experiences. To me, it can be eye-opening because, even if you know exactly what the guidelines say for your specific discipline, you should always consider other points of view and other modalities of treatment to identify the most therapeutically effective option for each patient.

What are some common misconceptions?

I think there are misconceptions about the many alternative colorectal cancer screening options, including stool tests, which are good options for people who are unwilling to go through a colonoscopy. I think some people are unaware of the screening tests for primary liver cancer, including ultrasounds for people who have cirrhosis. Many people don’t know there are effective treatments for hepatitis C, a major risk factor for liver cancer. For people who do receive a diagnosis of secondary metastatic disease in the liver, there are still effective treatment options, so it’s important to see a specialist.

How can I reduce my risk of liver cancer?

We’re learning more and more about the carcinogenic effect of alcohol consumption. Based on this evidence, we should all try to cut back on alcohol consumption as much as possible. Smoking cessation should be part of every conversation for anyone who smokes cigarettes or consumes nicotine in any form. Obesity is also a risk factor. All health care workers should have the hepatitis B vaccine. That’s an important way of preventing liver disease that can later turn into a cancer.

Are there clinical trials available at Massey?

Massey constantly evaluates the latest cancer therapies through one of the largest clinical trial offerings in Virginia. There are many ongoing clinical trials for this disease type, and we’re always trying to find new clinical trials that we can start here, whether they’re national trials or investigator-initiated trials from our own team.

For more information on clinical care related to tumors in the liver, click here.

Written by: Blake Belden