Aa
HCC/Liver resection with Stage 4 Cirrhosis
Dear Dr. Schiano,
My 55 year old husband was diagnosed with Stage 4 Cirrhosis and Hep C in 2000. He completed a year of Peg Interferon w/ Ribavarin in 2001, and has been virus-free since treatment. He has been under the care of a liver transplant team and has been monitored every 6 months (blood work, ultrasounds, etc.). He had level 4 esophageal varisces at one point, but currently there is only 1 near his stomach. He has always struggled with fatigue, sensitivity to heat and cold, and lack of appetite. He has been sober since 1999.
This past September, they performed an CT scan at his 6 month checkup. On Monday, we learned that he has HCC. I do not have any staging information right now other than knowing that there is at least 1 tumor under 1 cm in size. He has been referred to a surgeon (in the liver transplant group) to discuss surgery to remove this tumor. His liver is functioning, which I believe is why they are offering this option. He does not want to pursue a liver transplant due to personal beliefs, which I respect. Other family members of his died of liver disease, so we are familiar with the symptoms and challenges. He does not suffer from ascites yet, but does take Lactulose to prevent the mental confusion. His appetite has gotten worse over the past couple of months, but he makes it a point to try to eat something, even if he can't finish it. He sleeps through the night, but needs 2 naps a day.
My question has to do with surgery given his cirrhosis. His doctor has already told him that he has a higher chance of bleeding complications from surgery, and I am also concerned about his lung function during surgery as the CT scan revealed bilateral Atelectasis (which I understand to be areas of lung which are not fully inflated). We are meeting with the team on Monday, so I apologize for asking things that will most likely be answered at that time. Thank you in advance for any guidance or input you can offer.
My 55 year old husband was diagnosed with Stage 4 Cirrhosis and Hep C in 2000. He completed a year of Peg Interferon w/ Ribavarin in 2001, and has been virus-free since treatment. He has been under the care of a liver transplant team and has been monitored every 6 months (blood work, ultrasounds, etc.). He had level 4 esophageal varisces at one point, but currently there is only 1 near his stomach. He has always struggled with fatigue, sensitivity to heat and cold, and lack of appetite. He has been sober since 1999.
This past September, they performed an CT scan at his 6 month checkup. On Monday, we learned that he has HCC. I do not have any staging information right now other than knowing that there is at least 1 tumor under 1 cm in size. He has been referred to a surgeon (in the liver transplant group) to discuss surgery to remove this tumor. His liver is functioning, which I believe is why they are offering this option. He does not want to pursue a liver transplant due to personal beliefs, which I respect. Other family members of his died of liver disease, so we are familiar with the symptoms and challenges. He does not suffer from ascites yet, but does take Lactulose to prevent the mental confusion. His appetite has gotten worse over the past couple of months, but he makes it a point to try to eat something, even if he can't finish it. He sleeps through the night, but needs 2 naps a day.
My question has to do with surgery given his cirrhosis. His doctor has already told him that he has a higher chance of bleeding complications from surgery, and I am also concerned about his lung function during surgery as the CT scan revealed bilateral Atelectasis (which I understand to be areas of lung which are not fully inflated). We are meeting with the team on Monday, so I apologize for asking things that will most likely be answered at that time. Thank you in advance for any guidance or input you can offer.
MEDICAL PROFESSIONAL
with the HCV gone, it will take about 7-10 years before the cirrhosis can potentially regress enough to decrease the attendant risk of HCC. i presume the function of the liver is essentially normal, which makes curative resection a strong option. good luck.
MEDICAL PROFESSIONAL
chemoembolization and RFA are only infrequently curative while resection offers the best opportunity for cure and thus mitigating need for transplant
Dear Annab519, don't be worried. My dad had liver transplant in 2011. He was suffering from hep C and cirrhosis since 1996. He had the interferon injections and medications. However, his condition got worst in 2010 and had to go for the transplant. He had the transplant by Dr. K.C. Tan from Singapore. His is a very good clinic. The doctors and supporting staffs are really nice and cooperative. I don't know where you are from, and my prayer is with you and your husband. Best of luck!
why not considering of chemoembolization or radio frequency ablation ?
MEDICAL PROFESSIONAL
good luck. if his platelets are adequate it sounds like he could be a resection candidate.
Thank you, Dr. Schiano. His diagnosis is currently HCC with cirrhosis. It has been 11 years since his treatment for HCV and his viral load is 0. His liver function has been "normal" since then, despite his other worsening symptoms from cirrhosis. I appreciate your reply and hope to get more answers from his liver team. I was not aware that resection could offer any kind of curative treatment for HCC, especially with a cirrhotic liver, not that cirrhosis could regress. This is great information to learn.
You are reading content posted in the Liver Transplant Forum
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.
