When part of the liver is removed to treat cancer or other conditions, the remaining tissue must regenerate to restore liver function.  

In this Mayo Clinic Minute, Dr. Patrick Starlinger, a hepatobiliary and pancreas surgeon at Mayo Clinic Comprehensive Cancer Center, discusses research to help the liver regenerate after surgery. 

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How does the liver regenerate after surgery?

"The liver can regenerate quite dramatically, probably the most potential to regenerate in the entire human body, and we leverage this in liver surgery," says Dr. Starlinger.  

Before surgery, the team measures liver volume and assesses liver function to determine how much can be safely removed to take out the tumor while leaving enough healthy liver to regenerate.  

But in some patients, that regeneration does not happen, which can lead to liver failure and limit which tumors can be removed.  

"Our area of research is so important to understand the mechanism of liver regeneration in humans, particularly because as we understand the mechanism, we can move forward with interventions to promote regeneration in these patients," says Dr. Starlinger.  

What role does blood clotting play in liver regeneration?

Mayo Clinic researchers have analyzed liver samples from patients with healthy livers and those with underlying liver conditions to better understand what drives regeneration.   

"We were able to discover that the blood coagulation system is crucially important to allow these mechanisms of liver regeneration to actually occur," says Dr. Starlinger.     

More research is needed, but researchers hope these findings could eventually lead to treatments that promote liver regeneration and expand the limits of liver surgery.

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Instead of traditional implants manufactured in standard sizes, surgeons are using implants designed from a patient's own imaging. 

"The benefit of these is they're custom fitted for each particular patient," says Dr. Joshua Bakhsheshian, a Mayo Clinic neurosurgeon. "This gives us a little bit more control in terms of alignment restoration and also (vertebral) endplate coverage, which leads to better patient outcomes down the line." 

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Personalized implants, personalized care 

Creating the implant starts with a CT scan. Resulting images are used to build a three-dimensional reconstruction of the patient's spine. From that reconstruction, an implant can be designed to fit the space between the vertebrae where it will be placed. 

This personalized fit is part of an evolution in spine surgery toward better tailored treatments. 

"Modern-day spine surgery requires a lot of planning beforehand," Dr. Bakhsheshian says. "The operation is mostly done before you even get to the operating room." 

For patients undergoing spinal fusion, implants help maintain the space between vertebrae while the bones heal together. Porous titanium also allows bone to grow into and integrate better with the implant. 

Better outcomes through customization 

Dr. Bakhsheshian says customization can also mean less adjustment to the implant  during the operation. 

"They're personalized to each patient, which allows me to finish the operation quicker because there's less 'carpentry' that's needed in the operating room," he says. 

This level of precision can also benefit patients after surgery. 

"Patients tend to recover faster, and they're able to return to their level of activity as desired sooner," Dr. Bakhsheshian says. 

A spinal implant may be small, but its role in supporting alignment, stability and healing is important. 

"I'm very excited about this technology," Dr. Bakhsheshian says. "Ultimately, it can help provide better outcomes."

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Screening for prostate cancer can start with a blood test. A prostate-specific antigen, or PSA, test measures a protein produced by the prostate. An elevated level may indicate the need for further evaluation.

"Screening is important because the earlier you catch prostate cancer, the higher the likelihood of cure," says Dr. Albert Attia, a Mayo Clinic radiation oncologist.

Knowing when to begin screening is an important conversation to have with your healthcare team.

"Screening is recommended for men at the age of 50, and some data indicate it's better to get screened even at age 45, especially if you have a family history of prostate cancer," Dr. Attia says.

There are several treatment options when it comes to prostate cancer. Surgery, hormone therapy, radiation or a combination of those may be used.

One radiation option is intensity-modulated radiation therapy, or IMRT. The goal is to precisely target the tumor while limiting radiation to nearby tissue.

"This is a way for us to shape the dose of radiation to deliver the high dose areas to the tumor and avoid any critical structures nearby," says Dr. Attia. "We're able to achieve submillimeter accuracy."

Join the conversation at the Mayo Clinic Connect Prostate Cancer Support Group.

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This aggressive brain cancer can extend beyond what's visible on a standard MRI, making it difficult to precisely target treatment. Just 5% to 7% of patients survive five years after diagnosis. 

Mayo Clinic researchers are studying advanced imaging techniques designed to bring more of the tumor into view and potentially give care teams a better-defined target. 

"We're trying to develop and improve treatments that will help extend the length of time patients live, as well as their quality of life and function while they're alive," says Dr. William Breen, a radiation oncologist at Mayo Clinic. "From a radiation perspective, we need to be able to accurately see the tumor to accurately target it and treat it as well as possible." 

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Seeing tumors more clearly 

A standard MRI with contrast shows doctors where glioblastoma appears to be, but tumor cells can extend into the surrounding brain beyond what is clearly visible. 

"In over half of patients, we find a tumor more than a centimeter beyond the standard MRI-defined tumor, and in 20% of patients, we find a tumor more than 2 centimeters beyond the standard MRI-identified tumor," Dr. Breen says. 

To see more, Mayo Clinic investigators are combining advanced MRI techniques with research PET scans. The scans provide different clues, such as areas where cells are especially dense, where blood flow is increased or where there may be more aggressive tumor activity. 

Together, they can give doctors a more detailed picture of the tumor and where it may extend. 

Treating tumors more precisely and effectively 

Because glioblastoma can extend beyond what doctors see on a traditional MRI, radiation treatment generally includes an extra margin around the visible tumor to help cover cancer cells that may be hidden. 

Advanced imaging could help doctors more accurately identify those areas and tailor radiation accordingly. For some patients, that could mean treating a smaller area of the brain and reducing radiation exposure to healthy tissue. 

"By using advanced imaging, we're able to treat a smaller area in many patients and reduce the amount of normal brain receiving radiation, which may make for a safer and better treatment," Dr. Breen says. 

Researchers also are studying whether they can direct more intensive treatment toward areas that advanced imaging identifies as particularly concerning. 

Greater precision may make it possible to give a higher dose of radiation at each treatment and finish therapy sooner. Dr. Breen says treatment has been shortened from three to six weeks to one to two weeks for some patients, meaning fewer trips to the hospital and more time at home. 

Bringing specialties together 

The research brings together experts across Mayo Clinic, including neurosurgeons, radiation oncologists, neuro-oncologists, neuroradiologists and nuclear medicine specialists. 

"I think our strength at Mayo Clinic for treating glioblastoma is the multidisciplinary team," Dr. Breen says. 

While glioblastoma remains challenging to treat, advances in imaging, surgery, radiation, chemotherapy and other therapies are helping researchers continue to improve care. 

"We know there's still much progress to be made," Dr. Breen says, "but we have seen progress over the years to improve both quality of life and quantity of life for our patients with glioblastomas."

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A brain aneurysm, also called a cerebral aneurysm, is a bulge or ballooning in a blood vessel in the brain. Aneurysms generally fall into two categories: ruptured aneurysms, which are neurosurgical emergencies requiring immediate care, and unruptured aneurysms, which allow time to evaluate treatment and monitoring options. 

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"For unruptured aneurysms, we have the ability to plan and make a decision on the best treatment upfront in a nonemergent situation," says Dr. Chris Fox, a Mayo Clinic neurosurgeon.

But when a brain aneurysm ruptures, prompt medical attention is required. 

"Typically, when we see a patient with a ruptured aneurysm, we treat it as quickly as possible. That's usually within a matter of hours because there's a risk that the aneurysm can rerupture," he says.

Symptoms of a ruptured aneurysm can include severe head pain, nausea, vomiting, confusion and loss of consciousness.

"The classic presentation for a ruptured aneurysm is a patient has the worst headache of their life," Dr. Fox says.

Brain aneurysms are more common in women, and there may be a genetic component because aneurysms can run in families.

"But smoking and hypertension are two of the biggest risk factors for causing an aneurysm or having an aneurysm form," says Dr. Fox.

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Endometrial cancer begins in the endometrium, the lining of the uterus. 

"We are seeing an increase in patients under the age of 45, where particularly our patients who may be in their 20s or 30s and still want future fertility," says Dr. Evelyn Reynolds, a Mayo Clinic gynecologic oncologist.

Standard treatment for endometrial cancer is a hysterectomy, a surgery to remove the uterus. But for some younger patients who want to preserve their ability to become pregnant, there may be another option. 

"There are certain criteria that, if a patient meets, they may be a good candidate for fertility-sparing treatment," says Dr. Reynolds. "Lower-grade tumors that are confined to the endometrium are the ideal ones for treatment that can spare the uterus. There are different ways in which we can do targeted resection of the tumor."

Which is bringing hope to eligible patients who want to have children in the future. 

"We don't make assumptions. It's always a conversation with the patients, and it's a multidisciplinary approach," says Dr. Reynolds. "I want them to know that there are options." 

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Unlike many cancers that form solid tumors, leukemia is a cancer of the blood-forming cells in the bone marrow.

Dr. Arana Yi says, "Leukemia affects the production of the blood cells and can circulate through all the body from the beginning." 

Leukemia isn't a single disease. There are several types that can behave differently. According to Dr. Arana Yi, "It is a group of cancers with different subtypes. Some develop very quickly, while others progress slowly." 

Leukemia can affect people of all ages. Symptoms can include persistent fatigue, unusual bruising or bleeding, frequent infections, fever, night sweats, unexplained weight loss and shortness of breath. 

"If those are persistent, it is important to review and be evaluated by a doctor for a possibility of a blood count checkup," Dr. Arana Yi mentions. 

Research is helping doctors identify genetic changes that may be driving a patient's leukemia. That information can help guide treatment. 

Dr. Arana Yi says, "This allows us to use targeted medicines, immune-based therapies, sometimes with less traditional chemotherapy or chemo-free regimen." 

Recognizing possible symptoms and seeking medical evaluation can help doctors diagnose leukemia and determine appropriate treatment. 

"Recognizing symptoms since the beginning, and early evaluation with the doctors is key to diagnose the acute leukemia as soon as possible," Dr. Arana Yi concludes. 

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Dr. Sikander Ailawadhi, a Mayo Clinic hematologist and oncologist, explains how new therapies and ongoing research are changing the outlook for people with the disease.

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Multiple myeloma is a cancer that forms in a type of blood cell called a plasma cell that builds up in bone marrow.

"When plasma cells multiply and crowd up the bone marrow, they can produce certain abnormal proteins," says Dr. Ailawadhi.

Damage caused by multiple myeloma can lead to anemia, weakened bones, frequent infections and kidney failure.

"Treatment for multiple myeloma has come a long way," Dr. Ailawadhi says. "While historically, there were traditional chemotherapies, now, the focus of treatment is targeted therapies, which are frequently engaging the body's own immune system to try and target the cancer in a way that is safer and has a more sustained effect on the disease."

This includes bone marrow transplantation, novel immunotherapy agents and chimeric antigen receptor-T cell therapy, also known as CAR-T cell therapy.

Dr. Ailawadhi says research is ongoing to better predict who may be at risk for multiple myeloma and to develop new treatments.

"We are able to see the field advancing rapidly and how major treatment advances are progressing to benefit patients," says Dr. Ailawadhi. "We expect that over the next five, seven, 10 years, we will see many, many more drugs, novel combinations and agents with newer mechanisms will be available to patients with this disease."

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Glioblastoma begins in glial cells, the brain's support cells. When these cells become cancerous, they can grow rapidly into surrounding tissue, damaging the healthy brain they were meant to protect. 

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"It tends to be a tumor that also tends to grow and invade the brain," says Dr. Alfredo Quinones-Hinojosa, Mayo Clinic neurosurgeon. "Sometimes it can be slow and steady, but it tends to grow very fast." 

Despite significant advances in surgery, chemotherapy, immunotherapy and radiation therapy, glioblastoma remains one of the most challenging cancers to treat. Long-term survival is uncommon. 

"The median survival of patients with the best therapies tends to be between 12 and 14 months," says Dr. Quinones-Hinojosa. 

Although there is no cure for glioblastoma, treatment can help slow tumor growth, manage symptoms and maintain quality of life. Ongoing research continues to advance understanding of the disease and create new possibilities for patients. 

"Research is crucial to finding hope and healing in every corner of our operating room, in every corner of our laboratory," says Dr. Quinones-Hinojosa. "We are connecting research and hope, ultimately, through our patients." 

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Finding the right sunscreen can feel overwhelming, but experts say the most important thing is choosing one that offers broad-spectrum protection.

"You should be looking for a sunscreen that's at least SPF 30 that's broad spectrum, which means it protects against both UVA and UVB rays," says Dr. Collin Costello, a Mayo Clinic dermatologist.

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Ultraviolet (UV) radiation from the sun is the leading cause of skin cancer. Over time, UV exposure damages the DNA in skin cells, increasing the risk of abnormal cell growth and skin cancer. Both cumulative sun exposure and severe, blistering sunburns raise the risk of developing the three most common types of skin cancer.

"There's three common types of skin cancer: squamous cell carcinoma, basal cell carcinoma and melanoma. All three have been linked to too much UV exposure," says Dr. Costello.

In addition to helping prevent skin cancer, sunscreen also protects against premature skin aging caused by UV exposure, including wrinkles, brown spots and other signs of sun damage.

Using sunscreen is the single most effective way to protect your skin from UV radiation, which directly causes DNA damage, skin mutations and cellular breakdown. Regular daily use of sunscreen safeguards your long-term health and preserves your skin's structural integrity.

Dr. Costello says sunscreen should be just one part of your overall sun protection strategy.

"Sunscreen is always good to be using in conjunction with other sun-protective measures, like seeking shade; using sun-protective clothing, hats; and potentially avoiding the sun between 10 a.m. and 2 p.m., when the rays are the most intense," he says.

Learn more: Mayo Clinic Dermatology program

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