Transplants

[eekk]

Why are some people told they cannot be candidates when they seem to be doing ok and it is contained in one area? Is it not worth a try?

[carmik]

Sorry can you elaborate on what you mean. re doing ok and only in one area, what is?

[eekk in reply to carmik]

liver cancer- contained within the liver

[AyrshireK in reply to eekk]

Unfortunately as discussed earlier when you family member was first diagnosed they can only consider transplant where tumours are small enough or not near vital blood vessels as the risk of 'seeding' the cancer from a larger tumour is massive (they generally don't even biopsy a liver tumour because of this huge risk).

By operating (even transplant) they could spread cancer cells throughout the rest of the body. Sadly, there are few organs to go around and they have to give to those who stand the most reasonable chance of long term survival and if by giving a transplant they have spread cancer cells throughout the system then you wouldn't have a very long lived post transplant patient.

The following information is from the clinical protocol for transplant assessment for those with Liver Cancer (from the Scottish Liver Transplant Unit)

The diagnosis of hepatocellular carcinoma will normally have been established by a combination of CT, MRI scanning and by alpha-fetoprotein measurements. Biopsy of hepatocellular carcinoma should not be carried out where these investigations clearly point to the diagnosis to reduce the risk of tumour seeding.

A lesion must be seen on 2 forms of imaging with typical characteristics to count as HCC.

The size of a HCC will be the larger of the two if there is a discrepancy.

The listing criteria at present are:

Single tumour<5cm diameter

or

Up to 5 tumours all < 3cm

or

Single tumour between 5 and 7cm with no evidence of progression

(<20% volume increase) over a six month period. Locoregional therapy or chemotherapy may be given at this time.

•

A contrast CT scan will be carried out on ALL assessments. This can, and if

possible should, be done at the referring hospital. The duty radiologist will report the scans here during the assessment week.

•

MRI scan only for patients with suspected or proven HCC based on the initial CT scan.

•

Patients without HCC will not have an MRI scan

•

TACE (or RFA) will be offered to all patients on the waiting list with multifocal tumours, and all solitary tumours > 4cm, unless they have contraindications, eg poor synthetic function, or are likely to be transplanted very quickly.

Patients on the waiting list with diagnosis including HCC should undergo

alphafetaprotein (AFP) measurement at every clinic appointment and CT scanning every 4 months.

Extra hepatic metastases should be sought with a chest x-ray, CT scan of chest and abdomen before listing.

Sorry to say but in your family members case the tumour must either still be too big (even after TACE) or in such a risky area that they feel transplant is an unsafe option.

The question could be asked about the size and location and whether if the tumour shrinks enough they would consider T/P.

Wishing you all the very best,

Katie x

[eekk in reply to AyrshireK]

thanks Katie, there are two tumours one is slightly under the size requirements one is 0.5 cm over but hoping with the tace treatment and diet change it may have shrunk to under the size enabling transplant.

[AyrshireK in reply to eekk]

They are working on it with the TACE so keep fingers crossed. Obviously both will need to remain under 3cm and located in such a way as to allow operation without seeding cells. At this stage all you can do is hope TACE does it's job and there may still be hope for T/P.

Katie x

[Hidden]

Firstly I totally concur with every thing Katie has said, she is once again bang on the money. Two years ago when I had had an MRI and CT scans done, I was told I had five tumours on the liver, two of these were operable and these were burnt off by means of a liver ablation technique. (This is where lasers are used to burn off the tumours). I had to wait for the other three to grow big enough to be treated the same way. Fortunately for me, the biopsies showed the tumours not to be cancerous. The other three were burnt off some eight months later, but sadly once these little blighters start they'll keep on coming back.