Aa
Opinion on resection
Is resection a good option for patients who have cirhosis child A, hcv viral load 6000, genotype 3, HCC lesion less than 4 cm. LFT and AFP score is good
Friends,
Thanks a lot for your response. The patient is my dad and I am really worried about him. I havent yet discussed the problem with him and have been telling him its a benign tumor that needs to be removed either by resection or TACE. The problem here is that for some reason I feel I am not getting honest opinions from doctors and they seem to be pushing the case for transplant. I understand transplant is the best option for anyone, but then there are life long medicences "the ones that wont let your body reject the organ" that have to be administered. His bilurubin is 1.1, Alfa feto protien is 11. I'll post my question in the liver transplant section as well. I'll keep you guys posted. Thanks again
Thanks a lot for your response. The patient is my dad and I am really worried about him. I havent yet discussed the problem with him and have been telling him its a benign tumor that needs to be removed either by resection or TACE. The problem here is that for some reason I feel I am not getting honest opinions from doctors and they seem to be pushing the case for transplant. I understand transplant is the best option for anyone, but then there are life long medicences "the ones that wont let your body reject the organ" that have to be administered. His bilurubin is 1.1, Alfa feto protien is 11. I'll post my question in the liver transplant section as well. I'll keep you guys posted. Thanks again
Surgical Resection
This is the treatment of choice for HCC in non-cirrhotic patients, who account for just 5% of the cases in Western countries, and for about 40% in Asia. These patients will tolerate major resections with low
morbidity, but in cirrhosis candidates for resection cirrhosis candidates for resection have to be carefully selected to diminish the risk of postoperative liver failure with increased risk of death. Right hepatectomy in cirrhotic patients has a higher risk of inducing decompensation than left hepatectomy.
Recommendation
"10. To best assess the prognosis of HCC patients it is recommended that the staging system take into account tumor stage, liver function and physical status. The impact of treatment should also be considered when estimating life expectancy. Currently, the BCLC system is the only staging system that accomplishes these aims (level II)."
"Early stage disease includes patients with preserved liver function (Child–Pugh A and B) with solitary HCC or up to 3 nodules 3 cm in size. These
patients can be effectively treated by resection, liver transplantation or percutaneous ablation with possibility of long term cure, with 5-year survival figures ranging from 50% to 75%. Very early HCC is currently very difficult to diagnose confidently prior to treatment. In these lesions the absence of microvascular invasion and dissemination offers the highest likelihood of cure and thus, in Child–Pugh A patients may theoretically achieve a 5-year survival of almost 100%.
The intermediate stage consists of Child–Pugh A and B patients with large/multifocal HCC who do not have cancer related symptoms and do not have macrovascular invasion or extrahepatic spread. Their survival
at 3 years without therapy may reach 50%. These are the optimal candidates for transarterial chemoembolization (TACE).
Patients who present with cancer symptoms and/or with vascular invasion or extrahepatic spread comprise the advanced stage. They have a shorter life expectancy (50% survival at 1 year) and are candidates for sorafenib. Finally, patients with extensive tumor involvement leading to severe deterioration of their physical capacity [WHO performance status >2]214 and/or major impairment of liver function (Child–Pugh C)217 are considered end stage. Their median survival is less than 3 months."
Surgical Resection
This is the treatment of choice for HCC in non-cirrhotic patients, who account for just 5% of the cases in Western countries, and for about 40% in Asia. These patients will tolerate major resections with low
morbidity, but in cirrhosis candidates for resection have to be carefully selected to diminish the risk of postoperative liver failure with increased risk of death. Right hepatectomy in cirrhotic patients has a higher
risk of inducing decompensation than left hepatectomy. Two decades ago long-term survival was seldom achieved by resection. Today however, the 5-year survival after resection can exceed 50%. Several major advances have increased the long-term survival figures. Diagnosis during the asymptomatic
phase of disease together with a more accurate staging of the patients has allowed the identification of patients with early stage disease. At the same time, more accurate evaluation of the underlying liver function has permitted the exclusion of those in whom the resection would likely prompt liver decompensation and death. For years the selection of candidates for resection has been based on the Child–Pugh classification but this is known to have inconsistent predictive value. Child–Pugh A patients may already have significant liver functional impairment with increased bilirubin, significant portal hypertension or even minor fluid retention requiring diuretic therapy."
The bottom line is ONLY a hepatologist at a liver transplant center who knows your entire medical history, an oncologist and Interventional Radiology team can decide what the best treatment for you as an individual is. But generally speaking resection is not used in patients with cirrhosis.
HCC liver cancer not treated properly can be fatal and it not anything a layman can understand unless you study it for many months and have a lot of experience with. Cancer is an illness that is very complex and only a team of specialists working together can manage properly. It is a whole entire field of medicine to learn separate from cirrhosis and liver disease and hepatitis C.
I have been fighting liver cancer for over 2 years and am still learning new things about it all the time.
You should post this question in the "Expert Liver Transplant" community where a hepatologist can answer your question.
Good luck!
Hector
This is the treatment of choice for HCC in non-cirrhotic patients, who account for just 5% of the cases in Western countries, and for about 40% in Asia. These patients will tolerate major resections with low
morbidity, but in cirrhosis candidates for resection cirrhosis candidates for resection have to be carefully selected to diminish the risk of postoperative liver failure with increased risk of death. Right hepatectomy in cirrhotic patients has a higher risk of inducing decompensation than left hepatectomy.
Recommendation
"10. To best assess the prognosis of HCC patients it is recommended that the staging system take into account tumor stage, liver function and physical status. The impact of treatment should also be considered when estimating life expectancy. Currently, the BCLC system is the only staging system that accomplishes these aims (level II)."
"Early stage disease includes patients with preserved liver function (Child–Pugh A and B) with solitary HCC or up to 3 nodules 3 cm in size. These
patients can be effectively treated by resection, liver transplantation or percutaneous ablation with possibility of long term cure, with 5-year survival figures ranging from 50% to 75%. Very early HCC is currently very difficult to diagnose confidently prior to treatment. In these lesions the absence of microvascular invasion and dissemination offers the highest likelihood of cure and thus, in Child–Pugh A patients may theoretically achieve a 5-year survival of almost 100%.
The intermediate stage consists of Child–Pugh A and B patients with large/multifocal HCC who do not have cancer related symptoms and do not have macrovascular invasion or extrahepatic spread. Their survival
at 3 years without therapy may reach 50%. These are the optimal candidates for transarterial chemoembolization (TACE).
Patients who present with cancer symptoms and/or with vascular invasion or extrahepatic spread comprise the advanced stage. They have a shorter life expectancy (50% survival at 1 year) and are candidates for sorafenib. Finally, patients with extensive tumor involvement leading to severe deterioration of their physical capacity [WHO performance status >2]214 and/or major impairment of liver function (Child–Pugh C)217 are considered end stage. Their median survival is less than 3 months."
Surgical Resection
This is the treatment of choice for HCC in non-cirrhotic patients, who account for just 5% of the cases in Western countries, and for about 40% in Asia. These patients will tolerate major resections with low
morbidity, but in cirrhosis candidates for resection have to be carefully selected to diminish the risk of postoperative liver failure with increased risk of death. Right hepatectomy in cirrhotic patients has a higher
risk of inducing decompensation than left hepatectomy. Two decades ago long-term survival was seldom achieved by resection. Today however, the 5-year survival after resection can exceed 50%. Several major advances have increased the long-term survival figures. Diagnosis during the asymptomatic
phase of disease together with a more accurate staging of the patients has allowed the identification of patients with early stage disease. At the same time, more accurate evaluation of the underlying liver function has permitted the exclusion of those in whom the resection would likely prompt liver decompensation and death. For years the selection of candidates for resection has been based on the Child–Pugh classification but this is known to have inconsistent predictive value. Child–Pugh A patients may already have significant liver functional impairment with increased bilirubin, significant portal hypertension or even minor fluid retention requiring diuretic therapy."
The bottom line is ONLY a hepatologist at a liver transplant center who knows your entire medical history, an oncologist and Interventional Radiology team can decide what the best treatment for you as an individual is. But generally speaking resection is not used in patients with cirrhosis.
HCC liver cancer not treated properly can be fatal and it not anything a layman can understand unless you study it for many months and have a lot of experience with. Cancer is an illness that is very complex and only a team of specialists working together can manage properly. It is a whole entire field of medicine to learn separate from cirrhosis and liver disease and hepatitis C.
I have been fighting liver cancer for over 2 years and am still learning new things about it all the time.
You should post this question in the "Expert Liver Transplant" community where a hepatologist can answer your question.
Good luck!
Hector
i read a few websites on resection. the cirrhosis makes it quite risky. risk of liver failure is the detterent... goodluck barry
good question, other than size and shape, the cirrhosis has to be evaluated. the remaining lobe has to be able to support your entire liver function. barry
Sorry! I typed "reaction" and you stated resection. Please excuse my error.
DWBH
DWBH
Is reaction a good option for patients who have cirrhosis child A.
___________________________________
Could you give a better explanation of the above statement. A general background would help with getting your question answered. There are many knowledge people on this forum who can provide answers. You should also post your question in "Cirrhosis of the Liver". You may get additional responses to you posted questions.
Best To You
___________________________________
Could you give a better explanation of the above statement. A general background would help with getting your question answered. There are many knowledge people on this forum who can provide answers. You should also post your question in "Cirrhosis of the Liver". You may get additional responses to you posted questions.
Best To You
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