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HCC Update and Questions
firstly thank you kindly for everyone's feedback and support. So the current plan is TACE treatment and referral to transplant. The tumour is in section 8 so too hard to get too. But apparently we need to wait 8 weeks and do a battery of tests before treatment starts. His tumour is 4.7 cm. and cut off for transplant is 5cm. I think if the tumour migrates into the portal vein transplant is no longer an option. Couldn't this tumour get bigger in the next 8 weeks or move into his vein? How hard is the treatment going to be ?feeling a little hopeless at this point. Trying to remain positive.
Hey there! I wanted to say hello, welcome. Hector has given you excellent advice. Out of everyone on this forum, he is the most knowledgeable helpful person to answer your questions
He has been through it all and then some. He gives so much of his time, it is incredible. We all really appreciate what he does for all of us.
I hope that your husband does ok. I can understand your feelings. At times it feels like hurry up and wait which is very frustrating :)
Take Care, Dee
He has been through it all and then some. He gives so much of his time, it is incredible. We all really appreciate what he does for all of us.
I hope that your husband does ok. I can understand your feelings. At times it feels like hurry up and wait which is very frustrating :)
Take Care, Dee
Hi. Your questions are really liver cancer and liver transplant questions… But since the Medhelp expert Liver Transplant forum is no longer accepting questions, it would be best to post your questions in the cirrhosis forum where the discussion of cirrhosis and its consequences including the development of HCC (liver cancer) and liver transplantation are discussed.
That said...
"we need to wait 8 weeks and do a battery of tests before treatment starts."
All of us who have had treatments for HCC needed a complete assessment of our liver disease and overall health status before having any treatment for our liver cancer. TACE can only be performed in those healthy enough to undergo it. If the liver disease is too advanced TACE is not an option as it can cause further damage to the liver. Also sometimes TACE can’t be effective because of the location of a particular tumor. Since they are recommending TACE, which is the standard treatment for HCC, your husband appears to be healthy enough to have TACE as an option.
The tests are used also to assess the properties of the tumor, including its exact location in relation to its surrounding environment must to know before the procedure can be done, any particularities that would require adjustments in the procedure. Also the routing of the arteries that lead to the tumor are of utmost importance so the doctors can route the catheters to get to the tumor and inject the chemo beads.
Unfortunately preparing for any cancer treatment takes time. It can take sometimes weeks to schedule the OR and all of the doctors who will work on the procedure that along with up to date scans and blood tests to detect any changes that might have occurred since the last tests. Meaning what you are experiencing is normal. This type of medical procedure I assume is not something you are used to. So naturally of course it all seems worrying. Though we never get used to cancer treatment or liver transplant over time we learn to accept and go with the process.
One of the keys in dealing with the transplant process is to realize NOTHING happens quickly. The road to liver transplantation is a waiting game. Some of us waited many years to get our transplants. You will come to appreciate this as you go through the process and learn that rarely with liver cancer does anything change over night.
I would suggest getting to know the people at the transplant center (doctors, nurses, and social workers, whoever you come in contact with at the transplant center. These are the people that are going to save your husbands life. They are there to help you and your husband. This is what they do day in and day out. This is there norm. While transplantation and all that surround it can be very scary from the outside once you come to understand how these work you will see it all makes sense in achieving the goal of liver transplantation...saving the life of the patient who has either irreversible End-Stage Liver Disease or incurable liver cancer whose only cure is removing the liver along with the cancer before the cancer spreads. Liver transplant is a life saver but unfortunately it is a difficult process to go through.
"His tumour is 4.7 cm. and cut off for transplant is 5cm. I think if the tumour migrates into the portal vein transplant is no longer an option.
Yes, you are correct. Should the tumor grow into the portal vein then the liver cancer would become outside of the Milan Criteria for liver transplant and the person is not eligible for transplant. Is how it is described in the medical literature.
" Macrovascular invasion is defined as vascular invasion of either major portal veins or hepatic veins, and microvascular invasion as microscopic vascular invasion of the tumor by small vessels within the parenchyma of the liver."
"Couldn't this tumour get bigger in the next 8 weeks or move into his vein?"
Any HCC tumor potentially can grow into a vein. It depends upon exactly where the tumor is located and how close it is to particular veins.
Have the doctors said the tumor is close to portal vein?
How close?
Liver cancer, its treatment and liver transplantation are all very complex things. That is why he has teams of doctors working on managing his case. Even for doctors no one doctor could ever manage the care of a person with HCC needing a liver transplant.
How hard is the treatment going to be?
As with all things each person is different. Many of us have fatigue after the procedure. Some of us have initial pain or nausea for a couple of days afterward. But TACE is an Interventional Radiology procedure. It is not surgery. Have they explained it to you yet? So the recovery period isn’t extended like for example liver transplant surgery. The main thing is to realize that how your husband’s HCC is being managed is how HCC is typically managed in the transplant setting.
"feeling a little hopeless at this point."
Of course we were all scared when first confronted with liver cancer and the need for a liver transplant. None of us ever though this would happen to our lives. HCC and liver transplantation is for most of us was the first time we had to face or own mortality. There is nothing easy about that. There is no manual for how to deal with this situation. We all manage in out own ways.
After having 4 TACE, 3 PEI for over 2 years I was told that my liver cancer case looked hopeless a year ago now and I probably only had months to live. It was horrible beyond words. Yet I survived. So there is always room for hope no matter how difficult the situation may at first appear.
I would suggest if possible to attend a liver transplant support group at your transplant center so you can meet others going through the same situation you and your husband are. You will learn you are not alone in what you are feeling and thinking and you will meet those of us who are now living healthy lives after our transplants. Frankly only those who are going through the experience or have gone through it are going to understand what you and your husband are going through. Outside support is also very important too. Family, friends are all vital in getting through the inevitable ups and downs of transplant.
Hang in there. Stay hopeful! Try to take it one step at a time. (If we think about the big picture it is all too much for anyone to handle).
Let us know as things develop.
Hector
That said...
"we need to wait 8 weeks and do a battery of tests before treatment starts."
All of us who have had treatments for HCC needed a complete assessment of our liver disease and overall health status before having any treatment for our liver cancer. TACE can only be performed in those healthy enough to undergo it. If the liver disease is too advanced TACE is not an option as it can cause further damage to the liver. Also sometimes TACE can’t be effective because of the location of a particular tumor. Since they are recommending TACE, which is the standard treatment for HCC, your husband appears to be healthy enough to have TACE as an option.
The tests are used also to assess the properties of the tumor, including its exact location in relation to its surrounding environment must to know before the procedure can be done, any particularities that would require adjustments in the procedure. Also the routing of the arteries that lead to the tumor are of utmost importance so the doctors can route the catheters to get to the tumor and inject the chemo beads.
Unfortunately preparing for any cancer treatment takes time. It can take sometimes weeks to schedule the OR and all of the doctors who will work on the procedure that along with up to date scans and blood tests to detect any changes that might have occurred since the last tests. Meaning what you are experiencing is normal. This type of medical procedure I assume is not something you are used to. So naturally of course it all seems worrying. Though we never get used to cancer treatment or liver transplant over time we learn to accept and go with the process.
One of the keys in dealing with the transplant process is to realize NOTHING happens quickly. The road to liver transplantation is a waiting game. Some of us waited many years to get our transplants. You will come to appreciate this as you go through the process and learn that rarely with liver cancer does anything change over night.
I would suggest getting to know the people at the transplant center (doctors, nurses, and social workers, whoever you come in contact with at the transplant center. These are the people that are going to save your husbands life. They are there to help you and your husband. This is what they do day in and day out. This is there norm. While transplantation and all that surround it can be very scary from the outside once you come to understand how these work you will see it all makes sense in achieving the goal of liver transplantation...saving the life of the patient who has either irreversible End-Stage Liver Disease or incurable liver cancer whose only cure is removing the liver along with the cancer before the cancer spreads. Liver transplant is a life saver but unfortunately it is a difficult process to go through.
"His tumour is 4.7 cm. and cut off for transplant is 5cm. I think if the tumour migrates into the portal vein transplant is no longer an option.
Yes, you are correct. Should the tumor grow into the portal vein then the liver cancer would become outside of the Milan Criteria for liver transplant and the person is not eligible for transplant. Is how it is described in the medical literature.
" Macrovascular invasion is defined as vascular invasion of either major portal veins or hepatic veins, and microvascular invasion as microscopic vascular invasion of the tumor by small vessels within the parenchyma of the liver."
"Couldn't this tumour get bigger in the next 8 weeks or move into his vein?"
Any HCC tumor potentially can grow into a vein. It depends upon exactly where the tumor is located and how close it is to particular veins.
Have the doctors said the tumor is close to portal vein?
How close?
Liver cancer, its treatment and liver transplantation are all very complex things. That is why he has teams of doctors working on managing his case. Even for doctors no one doctor could ever manage the care of a person with HCC needing a liver transplant.
How hard is the treatment going to be?
As with all things each person is different. Many of us have fatigue after the procedure. Some of us have initial pain or nausea for a couple of days afterward. But TACE is an Interventional Radiology procedure. It is not surgery. Have they explained it to you yet? So the recovery period isn’t extended like for example liver transplant surgery. The main thing is to realize that how your husband’s HCC is being managed is how HCC is typically managed in the transplant setting.
"feeling a little hopeless at this point."
Of course we were all scared when first confronted with liver cancer and the need for a liver transplant. None of us ever though this would happen to our lives. HCC and liver transplantation is for most of us was the first time we had to face or own mortality. There is nothing easy about that. There is no manual for how to deal with this situation. We all manage in out own ways.
After having 4 TACE, 3 PEI for over 2 years I was told that my liver cancer case looked hopeless a year ago now and I probably only had months to live. It was horrible beyond words. Yet I survived. So there is always room for hope no matter how difficult the situation may at first appear.
I would suggest if possible to attend a liver transplant support group at your transplant center so you can meet others going through the same situation you and your husband are. You will learn you are not alone in what you are feeling and thinking and you will meet those of us who are now living healthy lives after our transplants. Frankly only those who are going through the experience or have gone through it are going to understand what you and your husband are going through. Outside support is also very important too. Family, friends are all vital in getting through the inevitable ups and downs of transplant.
Hang in there. Stay hopeful! Try to take it one step at a time. (If we think about the big picture it is all too much for anyone to handle).
Let us know as things develop.
Hector
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