Does anyone know if the 6 months alcohol free for HCC treatment applies to private treatment too?

[choc_2014]

My dad has another 3 months to wait for cancer treatment and there is no guarantee that by then the cancer wont have spread beyond treatment, id like to help him to access quicker treatment if possible?

[Bolly]

Hi choc, I can understand you are pretty desperate for something, anything to be done for your Dad. Did the doctors get as far as discussing what kind of treatment they would do once the 6-month not drinking has passed?

[choc_2014]

Hi Bolly, the consultant said he wanted to treat it locally as the tumours small. He was clear that was his preferred option but obviously hes not eligible at the moment. My Dads liver function has apparently improved greatly in the last 5 weeks, hes eating very healthily etc but hes living with a ticking time bomb.

[Bolly]

Hi choc, I'm looking up the EASL clinical guidelines for HCC liver cancer. Can you fill me in with a bit more info about what the consultant has said about treatment. When he says 'treat it locally' what does that mean? I presume with ascites it may mean the liver is too damaged for surgery, or has the consultant said surgery is an option? If not surgery then treatment would be some sort of chemo.

[choc_2014]

He didnt mention surgery but said it was quite easy to treat (which somehow makes it more frustrating) by inserting a needle into the tumour- I think its a form of targeted radiotherapy? The cirrhosis is class b to c, they cant decide as he has ascites but it has responded to treatment and no jaundice. Thanks so much for taking the time to look into it

[Bolly]

Okay - surgery is the first line treatment option, but is generally only available for small tumours and those with good liver function, i.e normal bilirubin, normal venous pressure and good platelet count. For surgery to be an option the rest of the liver has to be healthy enough to recover and regrow. I have no idea how much it was cost to have a resection done privately, £1,000's and £1,000's I would guess.

Liver transplant is an option for patients with tumours less than 5cm in size or 1-2 tumours each less than 3cm in size. Obviously the no drinking for 6 months rule comes in with this I believe, others are more knowledgeable on transplant rules than I am and its not something that can be done 'privately' for obvious reasons!

Then you have ablation as an option where either chemicals are injected into the tumour/liver or its treated with heat or cold. I think this procedure is sometimes referred to as TACE.

Then you have chemo. As yet there is no chemotherapy that has a track record or 'curing' HCC liver cancer but it can extend life.

The type of treatment options vary according to the overall health of the liver, something which I would hope your Dad's consultant has already discussed. Or have they not run through the options that are available.

It will be difficult to go the 'private' route without starting from the beginning again, i.e blood tests, scans, consultations etc which would all have to be paid for I presume unless he has health insurance.

There is a private liver clinic in London called the London Clinic thelondonclinic.co.uk/liver.... You could make some tentative enquiries there.

[Bolly]

When he says 'inserting a needle into the tumour' he may mean TACE en.wikipedia.org/wiki/Trans...

This means surgery is not an option, probably because your father's liver isn't healthy enough or the tumour is in an awkward place to remove surgically.

Be aware that when a doctor uses the word 'treat' in the case of cancer they probably mean a life extending treatment rather than the word 'cure. Sorry to be blunt, but liver cancer has a poor prognosis generally, though many people can live for years with treatment it's rare to be fully cured. I was 'lucky' that I qualified for surgery and will reach 5 years post surgery next year (only 50% reach 5 years post surgery without a recurrence), but due to the nature of HCC cancer I will be monitored for many years to come.

[choc_2014]

Its so kind of you to find this for me, thank you. He didnt run through the options at all, he literally just said he would treat it locally but hes not eligible. He then sent us straight to the cancer nurse who said it would be 6 months no drinking before treatment. The consultant we saw was gastro and he has an appointment in 3 weeks with the liver specialist at another hospital.

[Bolly]

I suggest that in the 3 weeks you have to research the options yourself and go with your Dad to the appointment with the liver specialist. I'm glad the gastro has re-referred him to a liver specialist as they should be more up to date on treatments.

The European Association for the Study of the Liver and the European Organisation for Research and Treatment of Cancer have jointly produced clinical guidelines for medics treating liver cancer. If you want to read it (its not too full of medspeak but obviously its heavyweight) you go to this website: easl.eu/_clinical-practice-...

then scroll down the guidelines till you get to Issue 7 April 2012 which is Management of Hepatocellular Carcinoma. You can download the whole document if you have Adobe software on your computer, or read it online.

Ultimately on the NHS you will have to go with what the hepatologist your Dad is under can offer, but I find it helps to understand what the options are so that you can at least say "why is he not suitable for this", or "is it possible for him to have that?". Then at least you know you have done the very best for him. Do you have a phone number or email for the cancer nurse? They are usually Macmillan Nurses? If so, the nurse should be available to answer questions for your Dad/you anytime, without you having to wait for a hospital clinic visit. Mine was fantastic, and gave me her phone, her email and her pager number.