?liver cancer/hepc

[kcrandy]

hi all ive been away for awhile but i am back
just heard from my last ct that i have an apprx 2.0 cm nod or some thing  that is on the right side of my liver. the gi doc has ordered an mri and a biopsy to see if this cancerous or not.  i need to know if you can tell me what im looking forward to.

a little history:
i went thru 54 wks of tx with peg and riba  cleared virus in 12 wks and stayed cleared for the rem wks of tx but the virus came back in 6 mths after tx. because to many complications in 1st tx my gi wanted to wait for newer drugs b4 tx again. i am stage 3 with cirrosis  too.  i am a geno 1a 54 yrs yung  and waiting;  then after two yrs of survallance this thing shows up.
i want to know if it is ok to do a biopsy without fear of a possible cancerous thing spreading.
i also need to hear the straight scoop of what i need to be prepared for if this does turn out to be cancerous and not begnine.  
thx everyone hope to get a response soon and for those who are going thru the tx hang in there it does work.

[kcrandy]

thx everyone for your responses they have and as always continue to be helpful .

i will let you all know after fri the 4th what my mri and biopsy results are.

[eureka254]

Sorry to hear that you're having to deal with this new development.  It is more frequent for lesions of the liver to be benign, and I hope that further evaluation shows your lesion(s) to be non-cancerous, but more imaging is certainly recommended; plus, the fact that AFP is close to normal range is in your favor.  However, I would be highly concerned about biopsy of the lesion itself, for the possibility of both sampling error and tumor seeding; usual guidelines would certainly include the MRI, but not before biopsy; perhaps biopsy after MRI, if suspicion of HCC is low.  

My husband was diagnosed with HCC back in 2007 and is still alive today to talk about it, so if it turns out that results are less than good, don't lose hope. Even though my husband could not undergo MRI (embedded schrapnel), he was advised against biopsy of the lesion because of concerns of spreading an already aggressive tumor.  Although his HCC was over 10cm, he was able to have surgery (re-section) to have that part of his liver removed.  I've learned over the years that it's important to get copies of all reports: imaging reports, blood results, etc., as much as possible.  It would be important to know exactly how many lesions were detected, what characteristics were seen in the imaging, and the locations and sizes of the lesions.  If you are Stage 3 damage (fibrosis), the likelihood of HCC is greatly reduced; however, if you are Stage 4 (cirrhosis), the risk for HCC increases.  

The number of lesions, as well their size, is a determining factor in transplant eligibility.  My understanding is that transplant is excluded for patients with HCC if:
(1) Single tumor size is greater than 5cm;
(2) Presence of more than 3 tumors;
(3) Of 2 or 3 tumors any one greater than 3cm
(4) Presence of metastasis
The first three guidelines are part of the what's referred to as "Milan Criteria" (MC) and is the current guideline for most transplant centers.  Some centers have pushed those guidelines -- as example, UCSF has expanded criteria to single tumor <6.5cm, 2-3 nodules less than 4.5cm or less than 8cm total -- but most center do follow MC protocol.

In some cases, like my husband, being ineligible for transplant does not necessarily exclude the possibility of surgical removal or other treatments, depending on the locations of HCC.  Hopefully you won't have to cross that bridge at all, but if you do, know there are those who have made it to the other side, and will try to help you whichever way we can. Hope that answers some of your questions, and keep us posted.  Wishing you best of luck and only good news. ~eureka

[babs824]

lest anyone forget that this is a very serious disease...as many of us achieve svr with out huge effort. it will take all of us to bring consciousness and funds to this horrible illness. my prayers go out to u during this very difficult time. so hard to make sense of things sometimes. stay with the support here for great advice and comfort. some of us are not qualified to answer some of the heavier questions for lack of experience. hang in, u will be responded to. hugs, babs

[kcrandy]

update:

i am told that there is at least 1 lessions measuring 4.0cm the others are considerably smaller. they are going to biopsy the 4.0 lession along with the mri.

i have been told that if i have any lessions over 3.0cm in size that i can not be a candidate for a liver transplant

anyway another set of deep info so i hope someone can respond to this latest info

thx all

[kcrandy]

thx for the responses.

i am stage 3 with cirrosis my afp is between 6-12 ng's.

sorry do not have a wife cant find a gal who could put up with me {o)....

sorry for the deep ref just trying to invoke response .

i will let you all know the results .  i am scheduled for ct guided biopsy on right side of liver next fri 3-4-2011 and my mri later that night. you are correct ku med is a good tx ctr and if it comes to transplant that would be my choice but my fate will in the hands of the veterans administration as to were a transplant would or could be.

as for all of you who are going thru the process, hang in there svr is and has been accomplished by many..............................

[Lonestar823]

I rest my case.  Hector to the rescue.

[Lonestar823]

I don't know.  I only know the first and the possible last part of this disease.  Being diagnosed, treating, failing and then treating again.  I kinda know the last part.  The part of dying from this disease, I mean, I've seen it close up at end stage but don't know anything about the medical stuff in between. It was a childhood friend come back from Viet Nam years later.

I only can believe that they wouldn't be giving you a biopsy if they thought further damage would occur.

Think I may have written to you once or maybe it was your wife, a long time ago.  Were you ever considering Infergen? I admire the courage it took to do the 54 weeks (I think you said) doing the Peg.

It's not that this subject is too deep in defense of my fellow forumers, it's only that some of us don't know or some that may be able to answer your questions just aren't here right now.  

Weeks and weeks go by sometimes for me before I check in.   Eventually I do though and I know I do remember you.  I remember all of you.  How could I not?  

Hope someone a heck of a lot smarter than I, checks in.

My best,
Lonestar

[HectorSF]

Hi welcome back, although the circumstance doesn't appear to be a happy one.

I believe you mean you are Stage 4 with cirrhosis?

If you have cirrhosis you should be seeing a hepatologist, hopefully at a liver transplant center. (The University of Kansas Hospital has a transplant center and has experienced docs that know how to take care of you). They take care of cirrhotic patients every day. Any other doctor is probably not qualified to treat you. Especially if you have liver cancer. The doctors there will know how to diagnose the lesion without creating a risk to yourself.

You say they believe you have a 2.0 cm lesion on your liver. It is possible to get liver cancer (HCC) if you have cirrhosis. The chances of getting HCC is between
2%-8% per year. This is why all cirrhotics need to have imaging done every 6 months and to have their AFP blood level monitored. Keep in mind all lesions are not cancers. I hope yours isn't.

The following paper will give you the latest AASLD Guidelines on HCC including how it is diagnosed, and treated.
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf

Some main points...
"Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances are typical of HCC (i.e., hypervascular in the arterial
phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be performed, or the lesion should be biopsied.
Biopsies of small lesions should be evaluated by expert pathologists. Tissue that is not clearly HCC should be stained with all the available markers...to improve diagnostic accuracy.
If the biopsy is negative for patients with HCC, the lesion should be followed by imaging at 3-6 monthly intervals until the nodule either disappears, enlarges, or displays diagnostic characteristics of HCC. If the lesion enlarges but remains atypical for HCC a repeat biopsy is recommended".

Let us know what happens and what the results are.
Best wishes!

Hectorsf

[kcrandy]

no respnses to deep i guess