3 month follow up of MRI on HCC

[Upbeat]

Hi
    I just got the results back for my 3 month follow up of MRI.  3 months ago the HCC was 9 MM  this result shows 1.1 Cm.  They state this is a stable HCC and to continue a 3 month MRI surveillance.  I don't understand the use of the term stable.  Is not 2 mm growth in 3 months growth?  Is the difference between 2 mm so close that its within the range of error?  I don't understand the word stable in this report?

[Upbeat]

I saw 2 Hepetologists last week and both gave me different opionins The first at UMC in Tucson  says that I should just get on the transplant and wait for the Tumor to grow to 2 cm and get a liver transplant because If I treat the tumor now then sometime in the near future my liver will fail anyway.  The second at Mayo in Phoenix said I should treat the Tumor now using something like Stereotactic Body Radiation Therapy (SBRT). then treat any more tumors that appear over time and transplant is the last thing I needed.  I find it hard to make choices with such different views.

[Thomas D Schiano, MD]

at 2 cms the hepatocellular carcinoma (HCC) can be treated and you can remain on the transplant list with priority that can be accrued over time.  Your hepatitis C (HCV) can be treated at any time during this process.

[Upbeat]

Thank You
I am some what confused,  Are you saying at 2 cm after I am placed on the list I could treat with RFA and stay on the list?  Or do you mean at 2 cm I could treat the Hep c and not lose anything?

[Thomas D Schiano, MD]

the low potential chance for overall cure of an HCC with RFA is greater when it is small.  I would always try and avoid the concept of transplantation as much as possible. at 2 cms the HCC allows you to be placed on the waiting list--at that point you could be treated and still accrue waiting time so that if the treatment doesnt work, you havent lost anything.

[Upbeat]

Hi
    I saw my doctor yesterday to discuss the 3 month results of my MRI. He said I had 2 choices.  I could do RFA and get rid of the tumor but after about 3 years my liver would fail because of the liver disease or I could start the approval process for a transplant and wait until the tumor grows.  Does this mean that at this stage there is no saving the liver?  I have not done treatment.

[Thomas D Schiano, MD]

if the HCC is the only indication for transplant, then treating it while its smaller, has a better chance for cure.  However, the overall chancde for cure is no more than about 20%--this is a gray area actually for transplant programs.  Treatment for the tumor should take priority over HCV treatment which cab be inutiated at any time.

[Upbeat]

Is the result different treating a 1cm tumor compared to a 2 cm tumor?  Would not treating a 1cm tumor have a better chance of cure than a 2cm?

What do you think at this point How I should proceed?

1   Do treatment then get on transplant list and get meld bump after tumor reaches 2cm
2   Do not do treatment and wait until tumor reaches 2cm then get on transplant list.
3   Do treatment and RFA  at same time or after treatment
4   Do not do treatment and do RFA
5   Wait on new drugs then do treatment then get on transplant list
6   Wait for three months then decide

[Thomas D Schiano, MD]

the HCC doesnt give priority on the transplant waiting list until it is 2 cms in size.  probably they want to wait until then and try to cure and potentially cure the tumor and at the same time start the waiting game for transplantation.  Once the wait is official for ther transplant then I think that HCV treatment should be started.

[Upbeat]

This is the the first line of the report.

Stable 1.1 cm hepatocelluar carcinoma in segment 4 B of the left hepatic lobe.  No new hepatocellular carcinoma. Multiple perfusion anomalies are present throughout the right and left hepatic lobes. Recommend continued 3 month MRI surveillance.  

I am not being treated for the HCC and don't know how to proceed.  Is this HCC treatable at this point?   Would it be better to treat the HCC now or wait and treat the Hep c now?  Or treat both at the same time?  I don't have a doctor appointment for a few weeks.  3 months ago I talked to a doctor at Mayo in phoenix and a doctor in Tucson at UMC. Neither advised me as how I should proceed.

Any insight you could provide would be greatly appreciated

[Thomas D Schiano, MD]

i dont agree with the assessment either.i think its relative--is the HCC being treated?