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Procedures

Gallbladder

Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.

Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone. Gallstone attacks usually happen after you eat. Signs of a gallstone attack may include nausea, vomiting, or pain in the abdomen, back, or just under the right arm.

Many gallbladder problems get better with removal of the gallbladder. Fortunately, the gallbladder is an organ that you can live without. Bile has other ways of reaching your small intestine.

Hernia

A hernia occurs when part of an internal organ bulges through a weak area of muscle. Most hernias occur in the abdomen. There are several types of hernias, including

  • Inguinal, the most common type, is in the groin
  • Umbilical, around the belly button
  • Incisional, through a scar
  • Hiatal, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
    Hernias are common. They can affect men, women and children. A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia.

The usual treatment for a hernia is surgery to repair the opening in the muscle wall. Untreated hernias can cause pain and health problems.

Thyroid

Your thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It is one of your endocrine glands, which make hormones. The thyroid helps set your metabolism – how your body gets energy from the foods you eat.

A thyroid gland that is not active enough is called hypothyroidism. It can make you gain weight, feel fatigued and have difficulty dealing with cold temperatures. If your thyroid is too active, it makes more thyroid hormones than your body needs. That condition is hyperthyroidism. Too much thyroid hormone can make you lose weight, speed up your heart rate and make you very sensitive to heat. There are many causes for both conditions. Treatment involves trying to reset your body’s metabolism to a normal rate. This can be done usually be done with medications.

A thyroid nodule is a lump in your thyroid gland.  These lumps, or nodules, are very common, with almost 15% of the populations having a lump on the thyroid.  The vast majority are benign (95%).  If a nodule is larger (greater than 1 cm), then a small needle biopsy is usually done.  If the cells are “normal”, then a repeat examination in one year is appropriate.  If the cells are “abnormal”, then a possible removal of the thyroid nodule along with that half of the gland is appropriate.  The doctor cannot simply remove the nodule, but must remove that lobe or half.  You only need one lobe to provide all the thyroid hormone that you need.

Thryoid cancer is uncommon.  Fortunately, the prognosis is generally excellent with surgery alone.  Occasionally, patients might also get a dose of radioactive Iodine for a final “mop-up”, depending on the findings from surgery.

Esophagus

The esophagus is a hollow tube that carries food and liquids from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include painful or difficult swallowing, weight loss and coughing up blood.

Risk factors for developing esophageal cancer include:

  • Smoking
  • Heavy drinking
  • Damage from acid reflux

Treatments include surgery, radiation, and chemotherapy. You might also need nutritional support, since the cancer or treatment may make it hard to swallow.

Esophageal cancer is not very common in the United States. It occurs most often in men over 50 years old.

Two main types of esophageal cancer exist: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is linked to smoking and alcohol consumption.

Barrett’s esophagus, a complication of gastroesophageal reflux disease (GERD), increases the risk for adenocarcinoma of the esophagus. This is the more common type of esophageal cancer. Other risk factors for adenocarcinoma of the esophagus include:

  • Male gender
  • Obesity
  • Smoking

Symptoms:

  • Backwards movement of food through the esophagus and possibly mouth (regurgitation)
  • Chest pain unrelated to eating
  • Difficulty swallowing solids or liquids
  • Heartburn
  • Vomiting blood
  • Weight loss

Exams and Tests
Tests used to help diagnose esophageal cancer may include:

  • Barium swallow
  • Chest MRI or thoracic CT (usually used to help determine the stage of the disease)
  • Endoscopic ultrasound (also sometimes used to determine the stage of disease)
  • Esophagogastroduodenoscopy (EGD) and biopsy
  • PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)

Treatment
When esophageal cancer is only in the esophagus and has not spread, surgery is the treatment of choice. The goal of surgery is to remove the cancer.

Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform.

If the patient is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable.

Liver

Your liver is the largest organ inside your body. It filters harmful substances from the blood, digests fats from food and stores the sugar that your body uses for energy. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

Risk factors for primary liver cancer include:

  • Having hepatitis
  • Having cirrhosis, or scarring of liver
  • Being male

Symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms and the cancer may not be found until it is advanced. This makes it harder to treat. Treatment options include surgery, radiation, chemotherapy or liver transplantation.

Liver Metastases means that some tumor has spread to the Liver.

The most common source might be the colon.  Other sources could be the pancreas, the esophagus, breast, or melanoma.

Your liver is the largest organ inside your body. It is also one of the most important. The liver has many jobs, including changing food into energy and cleaning alcohol and poisons from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion.

There are many kinds of liver diseases. Viruses cause some of them, like hepatitis A, hepatitis B and hepatitis C. Others can be the result of drugs, poisons or drinking too much alcohol. If the liver forms scar tissue because of an illness, it’s called cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Treatment of Primary Liver Tumors

Resection is possible for tumors that are small, when the liver is healthy.

Ablation can be done with probes that deliver heat (microwave or radiofrequency).  1-10 liver lesions can be ablated or destroyed in this way.

Intra-arterial chemotherapy can be done with different agents which clot the tumor.

Liver transplantation can occasionally be done in patients with cirrhosis and liver tumors

Treatment of Metastatic Liver Tumors

Resection is possible for many tumors

Ablation can be done with probes that deliver heat (microwave or radiofrequency).  1-10 liver lesions can be destroyed in this way.

Tumor Harvest for possible Vaccine therapy is a new options that may be possible.

Pancreas

The pancreas is a gland behind your stomach and in front of your spine. It produces juices that help break down food and hormones that help control blood sugar levels. Problems with the pancreas can lead to many health problems. These include

  • Pancreatitis, or inflammation of the pancreas: This happens when digestive enzymes start digesting the pancreas itself
  • Pancreatic cancer

The pancreas also plays a role in diabetes. In type I diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked them. In type II diabetes, the pancreas loses the ability to secrete enough insulin in response to meals.

Cancer of the pancreas is the fourth-leading cause of cancer death in the U.S. Some risk factors for developing pancreatic cancer include:

  • Smoking
  • Long-term diabetes
  • Chronic pancreatitis
  • Certain hereditary disorders

Pancreatic cancer is hard to catch early. It doesn’t cause symptoms right away. When you do get symptoms, they are often vague or you may not notice them. They include yellowing of the skin and eyes, pain in the abdomen and back, weight loss and fatigue. Pancreatic cancer can be treated with surgery, radiation and chemotherapy.  The exact timing of surgery and type of surgery depends on the xrays and other endoscopic tests which show how big the tumor may be.

Breast Cancer

Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include

  • Age – the chance of getting breast cancer rises as a woman gets older
  • Genes – there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
  • Personal factors – beginning periods before age 12 or going through menopause after age 55

Other risks include being overweight, using hormone replacement therapy (also called menopausal hormone therapy), taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.

Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.