Doctors blend an array of aggressive treatments for liver cancer

Surgery Vijay Khatri and his oncology surgery team

The ordinary moments are the ones that mean the most to Mike Zawilski: leisurely conversations over dinner, poolside cheering at a daughter's water polo match, preparing his signature feast of seared ahi for relatives.

In early 2004, Zawilski faced a future without such treasured everyday events. Lying on the exam table after a colonoscopy, he was told he had colon cancer, and later learned the disease had spread to his liver.

The prognosis for such patients is typically poor. But, thanks to an aggressive, integrated approach to his care by doctors at the UC Davis Cancer Center, Zawilski's cancer was under control, allowing him to enjoy life as a married father of two teenaged girls in Cameron Park, Calif.

"I still have challenges, but the quality of life is there," says Zawilski, 52, a retired information technology manager who worked in state government for 25 years. "It's a cliché, but I'm taking it one day at a time and cherishing the good times with family and friends."

Zawilski's doctors say his relatively strong condition nearly four years after diagnosis proves that a multidisciplinary treatment approach to such cancers can yield encouraging results. Vijay Khatri, the surgical oncologist on the team, says Zawilski's case was challenging because his colon cancer had spread to both sides of his liver. With chemotherapy alone, about half of such patients would be expected to survive 21 months, studies show.

Surgery can significantly extend that timeframe, Khatri says, with some patients living as long as 10 or 20 years. But Zawilski's cancer had invaded his liver to such an extent that surgery was initially not possible — and also too risky. That meant it was time to get creative.

Step one was to address the cancer in his colon, and then begin an intensive course of chemotherapy provided by Zawilski's medical oncologist, Tsuong Tsai of Cameron Park.

In a series of procedures, a team led by UC Davis surgical oncologist Vijay Khatri attacked the tumors that had invaded both sides of Zawilski's liver.

Doctors turned next to the liver, where they combined several treatments in a novel fashion to allow Zawilski to undergo removal of the liver tumors. First they used radiofrequency ablation to burn the tumors on the left side of the liver.

Increasingly common for small liver and kidney tumors, the procedure is performed with a thin needle inserted into a tumor with the help of computer tomography or ultrasound.

Dr. Khatri"If this case sends a message to the community, it is that they have these experts at their disposal, and that we can work in a multidisciplinary fashion with one goal — optimal outcomes for our patients. At a minimum, we can provide people with more time without tumors or improve their quality of life."
— UC Davis surgical oncologist Vijay Khatri

Radiofrequency energy channeled through the needle then superheats and destroys the tumor. Handling that segment of the treatment was UC Davis radiologist John McGahan, who pioneered this technique.

Zawilski was then ready for portal vein embolization. Performed by Daniel Link, a UC Davis radiologist who specializes in interventional vascular care, the procedure involves blocking blood flow to one side of the liver in order to enlarge the other side. The goal is to increase the size of the organ to the point where surgery to remove the remaining cancer lesions is safe. In Zawilski's case, the plan was to block blood flow to the right side to allow the left side, which had more healthy tissue, to grow. If all went according to plan, the right side of his liver could then be removed safely.

The results were impressive.

"When we went back and repeated the CAT scan a month later, we found the left side of the liver had increased in size by almost 30 percent," recalls Khatri. "That gave me a great advantage, and we were then able to take him to surgery and remove the right side of the liver. In fact, the left side of the liver had grown enough to enable us to safely remove even the tumors on the left side that had been previously ablased by Dr. McGahan. If we had not taken these innovative steps, removal of all the tumors would not have been possible without resulting in liver failure."

Khatri adds that, under ordinary circumstances, expanding the left side of the liver through portal vein embolization would also have caused the tumors there to grow. "But burning them with radiofrequency ablation before-hand prevented that," Khatri says. "That's why it is such a crucial part of our approach."

Once he recovered, Zawilski again was given a course of chemotherapy. Through it all, he says, Khatri's upbeat assessment of the treatments kept his family's spirits high.

"Dr. Khatri's demeanor and confidence in the procedures gave us a high degree of trust," says Zawilski. "It's amazing the technology they use nowadays. And I'm still here, so I certainly recommend it."

In the months since his treatments, Zawilski managed a family trip to his favorite destination — Kauai — and a few other vacations. Mostly, though, he's savored time spent with his wife, Kim, and daughters, Alexandra, 17, and Katherine, 14.

Over that summer he devoted countless hours to the girls' swim team, managing the computer system that tracks race times at meets. At the season-ending championship event, the Suburban Swim League honored Zawilski for his contributions, awarding him a thank-you plaque.

"That meant a lot to him, and to me," Kim Zawilski recalls. "He has been able to stay so strong for the kids and to stay very involved in their activities — not just as a spectator, but as a board member of the swim team, guiding how that institution runs. He's been through a lot, but he never falls into the pity pot, and that's an inspiration to a lot of us."

Mike and Kim Mike and Kim Zawilski.

Zawilski continued to receive chemotherapy to manage some tumors that have resurfaced in the liver area. "This is an aggressive cancer, but we're keeping a handle on it with my special chemotherapy concoction, and maybe a cure will come along," he says. "In any case, I have no complaints."

Khatri says Zawilski's "positive outlook is inspiring," and an asset to his health. He also hopes other patients will find solace in the fact that Zawilski, a patient whose cancer had metastasized to both sides of the liver, fared well thanks to a unique combination of treatments.

"If this case sends a message to the community, it is that they have these experts at their disposal, and that we can work in a multidisciplinary fashion with one goal — optimal outcomes for our patients," says Khatri, who published an article on the treatments used in Zawilski's case in a 2005 issue of the Journal of Clinical Oncology. "At a minimum, we can provide people with more time without tumors or improve their quality of life."

After battling a persistent infection, Mike Zawilski passed away on Oct. 10, 2007. His wife, Kim, expressed thanks to his medical team for their life-extending treatment.

"Their combined efforts gave Mike 42 months after diagnosis to enjoy his family and friends, which was twice as long as the initial prognosis. Mike fought the disease valiantly until the end, and he remained deeply involved in our daily lives until just before he passed away."

A memorial service was held Oct. 27, 2007.