Multiple lesions on liver> surgery? Transplant?

[eekk]

The consultant said surgery is not usually offered if there are multiple tumours on the liver but I have read online that many people have had surgery or transplants. Why do you think the doctor said this?

[AyrshireK]

This is what the Scottish Liver Transplant centre say about the transplant criteria for persons with Hepatocellular Carcinoma (HCC) - Liver Cancer. This will be similar if not the same for all T/P centres.

Hepatocellular Carcinoma (HCC):

The criteria for liver transplant for HCC have been revised because the Milan criteria which have been adopted in the UK for many years excluded some patients with a greater than 50% chance of survival at 5 years following transplantation, the benchmark used for transplantation for benign disease.

The lesions require to be identified on both MDCT and MRI scanning and have typical characterisation to count as HCC. This means an arterialized focal abnormality with portal phase washout on MDCT or Gd-enhanced MRI. Tumour rupture, extrahepatic spread, AFP >10,000 and macrovascular invasion are absolute contra-indications to transplant. The new listing criteria are as follows:

1- a single tumour ≤ 5cms diameter.

2 - up to 5 tumours all ≤ 3cms.

3 - a single tumour 5-7cms which shows no significant progression (volume increase <20%, no extrahepatic spread and no new nodule formation) over 6 months (during which time locoregional therapy may be given).

Contraindications

Extra hepatic malignancy, multifocal (more than 3) hepatocellular carcinoma and malignant portal vein occlusion. Tumours outside the previous mentioned criteria.

Muliple tumours or extra large tumours might pose a risk of rupture and cellular spread if operated on. Unfortunately they can't go in and transplant or resect if in doing so they will spread cancer cells into the rest of the body.

Really sad but the reality is by operating they could actually spread the cancer further through the system.

I hope that helps explain matters a bit. Sorry for your relative that this is the case.

Katie

[eekk in reply to AyrshireK]

Thanks for that Katie, so with multiple tumours it cancels it out then .The doctor did say if either liver or bile duct cancer is diagnosed then possibly chemo and/or radio may be talked about.We have another appointment with a different hospital in a few days

[eekk in reply to AyrshireK]

Are there many names for Liver cancer? or just one? They are looking at either bile duct cancer or liver cancer.

[AyrshireK]

It isn't something I have much knowledge of.

NHS says:- nhs.uk/Conditions/Cancer-of...

British Liver Trust has information at:- britishlivertrust.org.uk/li...

Primary liver cancers are cancers that start in the liver. The two main types are: Hepatoma, also called hepatocellular carcinoma (HCC) and Biliary tree cancer, which includes cholangiocarcinoma (bile duct cancer) and gallbladder cancer.

Best wishes, Katie

[eekk in reply to AyrshireK]

Thanks Katie the report says to rule out primary hcc and then mentions cholangiocarcinoma which it seems they suspects it is.The afp levels are not highly raised and we are told there is multifocal nodules regenerative nodes and borderline right hilar node.There is a history of a totally different cancer many years ago and also Hepatitis many years ago.

The skin is very itchy, very tired, small amount of blood loss from mouth and bottom, numb feet tinged blue nose and occassionally lips.

Feet look a bit swollen.

Fatty liver

High bilirubin and high ggt

Insulin resistant diabetic also has M.E

What direction do you think this is headed?

[eekk]

Has been sent to a heptologist?

[AyrshireK]

I wouldn't like to say as I am not medically trained and have zero experience about liver cancer of any type.

I think I will leave those sorts of answers to the doctors who have all the results and the patient in front of them as it is absolutely not in my capacity to say.

Wishing you all the very best of luck and for some answers a.s.a.p.

Katie x

[DeniB]

I had one tumour had a resection and ended up with multiple tumours in liver and mets in lungs. Surgery and recovery can lead to spread. Have you looked into TACE? I had two rounds of TACE which blocks the blood supply to tumours and stops growth. I'm now on an immunotherapy trial in Liverpool of pembrolizumab for HCC. Immunotherapy seems to be the way forward at the moment see if there's any trials near to you or within reasonable travelling time. It's done by drip once every three weeks minimal side effects

[KT60 in reply to DeniB]

Hi denib my husband has hcc he too is in liverpool tumour is very small and wont treat just monitoring. Can i ask did the hepatologist put you on this trial or was it an oncologist. He is only seeing hepatologist at moment in the royal hope you dont mind me asking.

[DeniB in reply to KT60]

My Oncologist in Birmingham sent me to see Prof Dan Palmer at the Royal who is running the trial at Clatterbridge. After three treatments had shrinkage in all tumours in liver and lungs. I don't know the full criteria other than a HCC diagnosis required to get on the trial. Can do no harm in asking?

[KT60 in reply to DeniB]

Thank you will much will ask at hcc hepatology clinic x

[KT60 in reply to KT60]

Sorry didnt finish post meant to say that is amazing that the tumours have shrunk so pleased for you karen

[eekk in reply to DeniB]

family member diagnosed now as hcc and will also be given tace at liverpool

[Chelle_]

Good Morning, I have 18 tumours on my liver 1-2 cm each the largest being a cluster of 5 at 8cm, they are all Benign thankfully which has enabled me to get on the tx list, I have been on there 11 weeks now. I hope you get the answers you want soon. Good Luck xx

[LKVVZ in reply to Chelle_]

Hi Chelle,

Today i did an ultrasound that showed 2 lesions on my liver ( i have fatty liver) and they said they are solid and round. One is 8mm and the other is 1.2cm. They asked me to go back in 3 months to see if they have grown but if i have cancer i cannot justify waiting. Can i please ask how they diagnosed you and were yours solid too? Do you have fatty liver? I am so scared

[Chelle_ in reply to LKVVZ]

It's ok to be scared. I was in hospital for 21 Days when I was first diagnosed. Everything happened quickly for me. Bloods, ultrasound, MRI, CT scan etc....I have never asked if they were solid or not, I haven't ever been told neither. I know when they first saw that I had them they thought I had cancer but soon told me this wasn't the case, just Cirrhosis of the Liver and Portal Vein Thrombosis for me (besides what else has been diagnosed).

I have always trusted my Dr and liver team with the things they have said and know that if they are worried then I need to be worried. I think if your Dr. has said we will see you in three months then I don't think he is worried about it being cancer, he would have you in sooner rather than later.

There would have been indications pop up in your blood samples, they would have taken a liver biopsy, CT scan, MRI etc....HOWEVER.....if you are concerned/not sure of your diagnosis, get a 2nd opinion. You are fully entitled to as for this. Don't sit and wait if your scared or worried, you will make yourself sick.

Please speak to someone else. Let me know what happens. Message me anytime you need to chat!!

Chelle x

[Danidontworry in reply to LKVVZ]

Hi. Can I️ ask how your doing? I️ was told I️ had one small cyst a year ago and now I️ have two, one is 2.5 cm. They don’t know if they are cysts or not. I️ just had an mri with contrast. I’m 41 and healthy, but really beginning to worry

[LKVVZ in reply to Danidontworry]

Hi darl, mine turned out to be benign lesions they call FND I believe. I was told by my specialist that I needed another MRI, the second MRI confirmed the findings and I was told I didn’t need to see him anymore. I know it’s scary but don’t think the worst. It’s most likely just a cyst or some benign lesion.

[Hidden]

Hi,

Welcome to the forum.

The British Liver Trust have a publication on liver cancer you may find useful, here is the link;

britishlivertrust.org.uk/wp...

It would be a good idea to seek out clarification regarding diagnosis from a liver specialist.

Warm wishes

Rebecca

[Bolly]

If its cholangiocarcinoma then its different to liver cancer, as the tumour(s) will be in the bile duct not the liver. Itchy skin is a typical symptom. I've had HCC and was never itchy nor jaundiced. I was 'lucky' that mine was a single tumour on the outer side of a lobe and was small enough to fit the criteria for surgery.

A deciding factor re surgery or no surgery is whether the cancer has spread to surrounding tissue. If it has, then surgery is usually a no no as the risk of 'seeding' the cancer further is too high.

You need a definite diagnosis of the type of cancer before speculating what happens next. An MRI should be able to diagnose the type well enough for the docs to make a decision on treatment options,

[Geffy22]

I wish you the best of luck ref treatment, but I do worry that we are not yet using all technology/innovation to its fullest effect.

Professionally, as I work in biotech, we are looking for 'orphan conditions' where the latest PDT molecule could be used in clinical trials. I do not yet know enough about what is classed as such -typically they are very rare conditions, but I do wonder if inoperable tumours should also fit this bill... if we have something that is affordable and to date is c100% effective in killing cancer, why not use it?

[eekk]

diagnosed with hcc of the liver. Being offered TACE as pallative not curative.Anyone had tace?

[DeniB in reply to eekk]

Had two rounds. It's not an easy treatment being awake whilst they do it. I couldn't have the embolisation bit as only one blood vessel into liver and they didn't want to risk the beads blocking it. Side effects lasted for about six weeks afterwards. Tiredness was draining and lost hair. It worked and held tumours at bay for 12 months.

[eekk in reply to DeniB]

Good news it held them back for twelve months. I was going to ask about hair loss, is that usual with Tace?

Was tiredness the main side effect or was there more? How do you feel now?

[Tangly in reply to eekk]

eekk, have you had your TACE now? My dad's recently had two rounds at the Royal.

[DeniB]

Yes tiredness was the worst bit totally knackered for weeks. It's a chemo to the liver so comes with similar side effects but at least it's targeted to where it's needed and not affecting the whole body. Was on Sorafenib at the same which messed with my appetite. Foods didn't taste right especially fish! Great now but that's down to the pembrolizumab trial so fingers crossed it continues to work. Another scan on Feb 1st.