Liver Cancer and Liver Metastases
Resection, histotripsy, ablation and transplant evaluation from one team
Tumors in the liver fall into two groups: cancers that start there, and cancers that spread there from somewhere else. Both are treatable, and the liver is unusual among organs in how many options we have. Dr. Papenfuss leads liver tumor care at Advocate Health St. Luke's in Milwaukee as part of a combined program with the transplant surgery team, serving patients from across Wisconsin.
What it is
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It usually develops in a liver already damaged by hepatitis, fatty liver disease or alcohol, which is why liver function matters as much as the tumor itself.
Intrahepatic cholangiocarcinoma starts in the small bile ducts inside the liver and is covered in more detail on our bile duct cancer page.
Liver metastases are cancers that have spread to the liver, most often from the colon or rectum, and also from neuroendocrine tumors, breast, pancreas, melanoma and other sites. For colorectal cancer in particular, removing or destroying liver metastases can be curative.
How it is treated
The liver regenerates, so up to about two-thirds of it can be removed in a healthy patient. The main options:
Liver resection, open or robotic, removing the tumor with a margin of healthy tissue. Still the standard with the longest track record.
Histotripsy, a non-invasive focused-ultrasound treatment that destroys liver tumors with no incision, needle or radiation. FDA-cleared for liver tumors and offered at St. Luke's since 2026.
Thermal ablation (microwave or radiofrequency), a needle-based treatment for small tumors away from major vessels.
Liver transplant, for selected patients with HCC and cirrhosis, through the transplant team.
Embolization and radiation, delivered by interventional radiology and radiation oncology when surgery or ablation is not the right fit.
Chemotherapy and immunotherapy, which for metastatic disease are usually the backbone, with liver-directed treatment added when the liver is the main site.
Dr. Papenfuss's approach
Every liver patient is reviewed at a joint conference of surgical oncologists, transplant surgeons, hepatologists, medical and radiation oncologists and interventional radiologists. That means a patient sees one plan, not five opinions. Dr. Papenfuss performs robotic liver resection and histotripsy, and works with the transplant surgeons so that patients who may need a transplant are evaluated early rather than after other options have been exhausted.
When to get a second opinion
If you have liver metastases and were told surgery is not an option, or if histotripsy has not been discussed, a review by a combined HPB and transplant team is worth the call. Patients come to Milwaukee from across Wisconsin and neighboring states, and a records review can happen before you travel.
Call 414-649-3240 to request a consultation.
This page is general information, not medical advice for any individual patient.