Aa
Screening for cancer after SVR
First I want to say hello and hope everyone is benefiting from all the new treatments.
I moved to Florida and found a GI that I see locally. He wants me to have an ultrasound and a blood test for AFP every six months even though I am SVR for 4 years now and my fibrosis is improving. I searched the web for treatment recommendations for SVR patients and couldn't find anything meaningful that talked about liver cancer rates after SVR.
This seems aggressive to me and not something I am willing to do without some studies that show a high risk for liver cancer after SVR.
Anyone have any data that might be useful?
Thanks,
Eric
I moved to Florida and found a GI that I see locally. He wants me to have an ultrasound and a blood test for AFP every six months even though I am SVR for 4 years now and my fibrosis is improving. I searched the web for treatment recommendations for SVR patients and couldn't find anything meaningful that talked about liver cancer rates after SVR.
This seems aggressive to me and not something I am willing to do without some studies that show a high risk for liver cancer after SVR.
Anyone have any data that might be useful?
Thanks,
Eric
This is the latst from CCO . based on patient profiles. In this case it is recommended he get frequent HCC screening,however I have never read anything about screening for St patiens if they had eradicated the virus sussefully..God to see you Eric.. all the best
Will
Patient Case: Posttreatment Monitoring of Patients
The patient is a 56-year-old white male with genotype 1a HCV infection. A previous liver biopsy in 2009 revealed stage 3 bridging fibrosis. Laboratory findings are as follows: AST is 56 U/L, ALT is 47 U/L, total bilirubin is 0.8 mg/dL, albumin is 3.9 g/dL, prothrombin time 7.8 seconds, white blood cell count of 3.4 x 103 cells/μL, hemoglobin is 11.6 g/dL, and platelet count is 112,000 cells/μL. He is treated with telaprevir-based therapy for 12 weeks followed by peginterferon/ribavirin to Week 24, at which point he declined further therapy. HCV RNA is undetectable at treatment cessation and remains undetectable 24 weeks later.
How will the patient need to be followed in the coming years?
Analysis by Donald M. Jensen, MD:
HCC surveillance should be performed every 6 months for the remainder of this patient’s life. It is likely that this patient has cirrhosis based on his AST:ALT ratio and the presence of thrombocytopenia. The 2009 biopsy probably underestimated his degree of fibrosis, which is not uncommon. According to AASLD guidelines,[2] he should have received 48 total weeks of treatment, but he did respond successfully to 24 weeks. Patients with cirrhosis require continued surveillance for HCC since the risk persists, albeit reduced.[19] The risk of hemorrhage from esophageal varices, however, is nonexistent following SVR, and endoscopic surveillance for these is not necessary.[37]
Will
Patient Case: Posttreatment Monitoring of Patients
The patient is a 56-year-old white male with genotype 1a HCV infection. A previous liver biopsy in 2009 revealed stage 3 bridging fibrosis. Laboratory findings are as follows: AST is 56 U/L, ALT is 47 U/L, total bilirubin is 0.8 mg/dL, albumin is 3.9 g/dL, prothrombin time 7.8 seconds, white blood cell count of 3.4 x 103 cells/μL, hemoglobin is 11.6 g/dL, and platelet count is 112,000 cells/μL. He is treated with telaprevir-based therapy for 12 weeks followed by peginterferon/ribavirin to Week 24, at which point he declined further therapy. HCV RNA is undetectable at treatment cessation and remains undetectable 24 weeks later.
How will the patient need to be followed in the coming years?
Analysis by Donald M. Jensen, MD:
HCC surveillance should be performed every 6 months for the remainder of this patient’s life. It is likely that this patient has cirrhosis based on his AST:ALT ratio and the presence of thrombocytopenia. The 2009 biopsy probably underestimated his degree of fibrosis, which is not uncommon. According to AASLD guidelines,[2] he should have received 48 total weeks of treatment, but he did respond successfully to 24 weeks. Patients with cirrhosis require continued surveillance for HCC since the risk persists, albeit reduced.[19] The risk of hemorrhage from esophageal varices, however, is nonexistent following SVR, and endoscopic surveillance for these is not necessary.[37]
Sold the boat. It's too shallow for a cruising sailboat on the west coast. Some people do have them, but it's not great sailing and my wife is tired of it. Thanks for asking though. I hope all is well with you.
I have already been in a Telaprevir (which is Incivek), trial, back in 2007. At that time, I was exposed to the Telaprevir, but I was randomized into the "NO RIBA" group. So all I go was Telaprevir and Peg. I had a big drop in my viral load initially, but since there was no Riba in the mix, I had breakthrough and my viral load went back up, rebounded quickly at week 3. I was kicked out of the trial due to non-response by week 5. Since I've been exposed to Telaprevir, no other doctors (including Schiff), want me to do another treatment with any drugs in that same class. In other words that don't want me retreating with Telaprevir(Incivek) or Boceprevir(Victrelis), due to the previous exposure to Telap and resistance... None of the new trials for all orals have had a spot for a null responder/Telaprevir failure patient (who didn't get all 3 drugs). So, that why I'm not doing any treatments. I've already done 11 treatments in my HCV life (4 TX's were trials), 1 TX was a maintenance dosing regiment, all the rest of the 6 TX's were full scheduled TX's with normal dosing or double dosing. My last bio #5 showed about a stage 2 no bridging - which went along with that fibroscan that was done down there by Schiff last year. But, Bio#3 and Bio#4 showed bridging fibrosis. When I had a baseline upper endoscopy, my esophagus was free of varices (a good thing). I think my GI is just monitoring me for liver cancer-just to be safe. Susan400
Nothing to add to the good advice given above, but just wanted to welcome you to the Sunshine State. Think it should be renamed to the Rainy State with the amount of rain falling recently. Hope you're happy with your GI.
How nice to see you here.
How's the boat ?
After I get my 6 month SVR in September I will not be doing cancer screening.
My reasoning is that nobody in my close family has had cancer and even more important, despite being close to dying from ESLD, I never developed liver cancer. Genetically I believe I am not predisposed to the the big C.
Most doctors make decisions based on graphs and statistics, not on individuals. Our doctors are our guides. Ultimately our health decisions are ours to make.
I'm moving forward away from fretting over my health:)
Wishing you the best~
OH
How's the boat ?
After I get my 6 month SVR in September I will not be doing cancer screening.
My reasoning is that nobody in my close family has had cancer and even more important, despite being close to dying from ESLD, I never developed liver cancer. Genetically I believe I am not predisposed to the the big C.
Most doctors make decisions based on graphs and statistics, not on individuals. Our doctors are our guides. Ultimately our health decisions are ours to make.
I'm moving forward away from fretting over my health:)
Wishing you the best~
OH
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
