64yo male, had Hep C (almost 20 yrs), cirrhosis, diagnosed cancer 5cm (march 2007), chemoembolization (5/2007), Liver transplant (9/2007) found tumor was almost 10cm after surgery. start taking Nexavar 200mg 1-2 BID (dosage depend on diarrhea), take Neupogen 300mcg per week and cellcept, prograf etc, have HBP with medications.
had mild chemotherapy (18mg Adriamycin ) 6 times monthly done by 2/2008.
MRI 4/30/2008 shows no growth and clean, but APF was high ( MD told tme that it's because of transplant and not worry about it).
MRI 9/22/2008 with impression:
Interval development of heterogeneous mass/node about 2.5x2.1x3.7cm along the gastrohepatic ligament for which recurrent/matastatic disease cannot be excluded. Consider PET CT evaluation to see if there is any suspicious metabolic activity. also left lobe is atrophic and left protal vein is dimunitive. and I will do PET as soon as possible.
If this is recurring cancer which is quite possible to me.
What is the best treatment option do I have ?
Can you do liver surgery again and remove parts of liver with cancer ? and systemic chemotherapy to be followed ? or radiations ?
What are the prognosis or life expectancy ?
OR what other alternatives are available and to recommend with good prognosis ?
Hi. The best treatment option will depend to a certain extent on the results of the PET scan. If other lesions are noted aside from the 3.7 cm mass seen on MRI, surgery might not be feasible, and you may just be treated with another course of chemotherapy. Nexavar or a similar drug, Sutent may be useful in this setting. If no other lesions are seen in the PET scan, it may still be possible to surgically remove the 3.7 cm mass. After the surgery, chemotherapy most likely will have to be done. If you still have an active Hepatitis C infection, treatment for this may have to be given as well. I don't see any role for radiation treatment in this situation.
The prognosis for your case is not very clear. I am not aware of any available statistics regarding survival in patients with recurrent cancer after liver transplantation. What I can tell you is that recurrent disease has a poorer prognosis in any setting.
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