2nd opinion

[slowcat]

I have Alpha -1 which has caused me to contract cerohsis of the liver.  I was diagnosed with it a little over a year ago.  My Doctors are at University of Michigan liver transplant clinic and I do have confidence in them but would also like to get a second opinion or another avenue with what I am about to tell you.  I went in for a yearly MRI and in this test they found a tumor on my liver.  They gave me a c/t scan for my chest which came back clear.  The next step was to biopsy the tumor but they were not able to see the tumor with an ultrsound to get to the tumor so this could not be done.  Now they want to just zap the tumor with chemo through the vessel that leads to the tumor. Is this a good decision in your opinion or might there be a different avenue that has not been looked at seeing that they are not sure if the tumor is cancerous or not?

[slowcat]

Thanks for the response it does help.  I am on the transplant list and have been for about a year.  My meld scores have stayed consistant through this at about 13 - 14.  I am a patient at University of Michigan Hospital.

[mikesimon]

Here is another approach to HCC.

Transplant Proc. 2011 May;43(4):1091-4.
Microwave thermal ablation for hepatocarcinoma: six liver transplantation cases.

General Surgery and Organ Transplantation

Surgical resection for malignant hepatic tumors, especially hepatocarcinoma (HCC), has been demonstrated to increase overall survival; however, the majority of patients are not suitable for resection. Radiofrequency ablation (RFA) is the most widely used modality for radical treatment of small HCC (<3 cm). It improves 5-year survival compared with standard chemotherapy and chemical ablation, allowing down-staging of unresectable hepatic masses. Microwave ablation (MWA) has been extensively applied in Asia and was recently introduced in the United States of America and Europe with excellent results, especially with regard to large unresectable HCC. Our single-center experience between May 2009 and October 2010 included application of MWA to 154 patients of median age ± standard deviation of 63.5 ± 8.5 years, 6 males, and 1 female, of mean Model for End-Stage Liver Disease (MELD) score (10.1 ± 3.8). The HCC included, hepatitis C virus (HCV)-related (n = 70; 45.5%); alcool (ETOH)-related (n = 42; 27%), hepatitis B virus (HBV)-related (n = 16; 10.5%); and cryptogenic cases (n = 26; 17%). The cases were performed for radical treatment down-staging for multifocal pathology or bridging liver transplantation to orthotopic (OLT) in selected patients with single nodules. A computed tomography (CT) scan was performed at 1 month after the surgical procedure to evalue responses to treatment. Among 6 selected patients who underwent OLT; 5 (83.3%) showed disease-free survival at one-year follow-up. The radical treatment achieved no intraoperative evidence of tumor spread or of pathological signs of active HCC among the explanted liver specimens. In conclusion, a MWA seemed to be a safe novel approach to treat HCC and could serve as a "bridge" to OLT and down-staging for patients with HCC.

http://www.ncbi.nlm.nih.gov/pubmed/21620060

[eureka254]

And, of course, if you are unsure of the best approach seeking a second opinion from another doctor/center is always a good option.

[eureka254]

Sorry to hear that you're having to deal with this.  My husband has a history of cirrhosis and liver tumor as well, and I know it's a tough place to be.  Usually diagnosis of the most common liver tumor, hepatocellular carcinoma (hcc), does not require biopsy.  Generally, AFP levels and imaging (CT-Scan or MRI) is 'sufficient' to make diagnosis, although of course it is not without error.  My husband was diagnosed with hcc in 2007 and the way it was explained to me was that certain characteristics on imaging often make biopsy unnecessary, and in some cases, a serious risk because of 'seeding', or spreading tumor via the biopsy needle.  

Transplant centers are often the best equipped to diagnose, manage, and treat hcc.  You did not mention currently being listed or your MELD score, or whether your are compensated or decompensated cirrhosis, but depending on your particular region and Transplant Center, having hcc may increase your priority for listing; however, it is not the case for every Transplant Center, and it's a discussion you should be having with your doctors.  Some regions will give priority points for 'zapping' tumors (I presume you mean Trans-Arterial Chemo-Embolization or TACE) and showing response, but at other Centers, having good response to TACE does not impact your MELD score at all.  This should be a consideration and a point of discussion with your doctors, if transplant is an option for you.  If you are considering TACE and/or transplantation, it's also a good idea to ask what your options would be if TACE does not show effectiveness.  It's a tough decision with many variables, and it would be important to understand your doctor's rationale for recommending TACE at this time vs other options.

As far as TACE itself goes, my husband has had 3 TACE procedures in the past year, and for him, they worked to stop the tumors from growing, and he's currently without active hcc.  The procedure itself usually requires an overnight stay at the hospital -- all three times my husband was discharged the day after the procedure.  Depending on the current status of your liver (cirrhosis at Class A usually tolerates intervention fairly well), it may present some risks, so hopefully your doctor discussed in detail with you the reasoning behind his recommendation.  

If you pursue TACE, the next step will most likely be a consultation with a radiologist, so get yourself ready and start a list of questions to take with you to the visit.  Whether it's the right approach for you depends on many things, not only limited to what you want, but also in terms of asking about and understanding what will be available to you as next step options, depending on your choices and progress.  

Hope that helps some, and good luck on all this moving forward.  ~eureka