[Cancer of the liver, pancreas, gallbladder, and bile duct]

In cancer of the liver, pancreas, gallbladder, and bile duct, symptoms and signs are non-specific compared with benign conditions. Early detection is difficult and long term survivors are extremely low. The role of systemic chemotherapy in patients with these malignancies is only palliative. Prolongation of survival has not been demonstrated with any single agent or with any combination chemotherapy. However, in some instances, useful symptomatic palliation may occur even without an objective partial response. Quality of life is an important parallel endpoint in these malignancies. In advanced cancer of the liver, numerous alternative therapies have been investigated. These include pharmacologically based chemotherapeutic delivery methods, percutaneous alcohol injection, TAE, TACE, etc. However, further rigorous investigations will be warranted. It is hoped that successful chemotherapeutic agents or other modalities can be developed and combined with limited efficacy of surgery and radiotherapy. In this respect, newer, more active chemotherapy regimens are clearly needed.