HCC - transplant, resection not an option

[bobsmith1276]

Hello,

I am a 75 year old male recently diagnosed with HCC.  I have a 9cm tumor along with a few cysts and mild cirrhosis.  I do not drink or smoke and have never had hepatitis.  They believe this is due to a fatty liver or obesity.  I am being told that due to my age and underlying cirrhosis, that resection of this tumor or transplant are not options for me.  I was told it is not blocking any important veins and has not spread outside of the liver.  My doctors are recommending radiation using cathederized spheres to shrink or slow the tumor growth.  I do not really have any symptoms of HCC as this mass was discovered during a CT scan for some stomach pain that I was having one day, and follow up MRI was ordered.  The biopsy came back negative on the mass, however, my group of doctors agreed that this should be treated as HCC and that this radiation treatment was the best (and really only) option.

I was just looking for other opinions from any medical experts or anyone that has gone through this.  I am relatively healthy otherwise, but when I look at statistics about HCC and that my only option seems to be palliative treatment, that I may only have a few months to live.  This would make more sense if I was sick or had any symptoms of late stage liver disease, but i am pretty active for my age and I really only have heartburn/indigestion every now and then.  What also confuses me is that this same mass was found on my liver in 2008, was deemed benign, and it really hasn't grown much since then.  So my other questions are, why wasn't anything done in 2008, what is different now, and if I haven't had any symptoms, is it really worth going through radiation where I risk further damage to the healthy part of my liver?

I appreciate anyone's comments/thoughts.  I also do respect my doctors' opinions and do have to speak with them further about my prognosis, but I just felt it would be a good idea to get more than one opinion and have other ideas to bring up to them when I meet with them to finalize a treatment plan.  Also, if you can suggest any other questions that I should ask them, I would greatly appreciate it.  Thank you.  

[bobsmith1276]

Thanks, fntn.  I also followed your advice and got 2nd and 3rd opinions about resection or transplant, but everyone was in agreement that the portal hypertension and my high blood pressure with heart stent were just too risky for surgery of that nature.  So our goal is just to maintain the pallative care and keep the HCC contained and non-active for as long as possible.  They're saying that the cirrhosis from all my meds might actually be what gets me in the end.  Hopefully that's still a little while away, but you never can tell.  I hope everything is going as best as possible for you and your challenges and thanks again for your input.  Hearing back from people who are actually going through some of the same difficulties is sometimes more helpful and comforting than just listening to doctors all the time.  

[fntn]

It's great news wrt non-active HCC lesions! Hopefully this will remain so. There are success stories out there, and I'm glad you are one of them.

[bobsmith1276]

Thanks for your feedback.  Good news is that the radiation practically killed the HCC tumors.  They were going to do TACE for my next treatment, but when they went in, the doctors noticed that none of the tumors were active and didn't want to poison the good parts of the liver without having much reason.  Cirrhosis is still there obviously, but my liver function tests are very good considering.  My spleen is still enlarged and my platelet counts have been low, so they gave me a platelet transfusion.  I go back in a few months to check on the tumors and see if the TACE becomes necessary, but other than that they are just telling me to watch my diet to keep the cirrhosis progression as slow as possible.  There's concern about the platelets, but they said that is expected with cirrhosis and HCC.  So keeping my fingers crossed that the HCC stays sleeping and that i can manage the cirrhosis and other issues as best as possible to hopefully get as much healthy time remaining as I can.  

[fntn]

Generally doctors will tend to think of liver lesions as HCC unless proven otherwise, in patients who have cirrhosis. But given that the tumor was considered benign (what was the original classification?) back in 2008, it hasn't grown in the past seven years and the biopsy was negative - I'd definitely get a second opinion from another cancer tumor clinic. I'd try either Mayo or the Cleveland Clinic since they're rated number 1 and 2 wrt liver diseases, etc.

The other consults may lead to different treatment options as well, if it does prove to be HCC. I've dealt with the same situation recently, given my tumors and the fact that I have ESLD with portal-hypertension and ascites. I went to several different hospitals and all the surgeons decided that surgery/resection was not possible. The problem is basically that when we have ESLD, the portal blood pressure is very high, and controlling the bleeding during an resection can be very difficult, leading to bleeding out in the operating room. But my current Liver Team did decide that they would take the chance with a resection. So risk-reward assessments do vary across our various hospital systems.

Radiation is an option but it's only palliative as you've noted. They can spare most of the healthy portions of your liver but they do have to respect the margins around the tumor. So that unfortunately doesn't leave a lot of good liver left.

Please keep in touch and feel free to email me if you have any other detailed questions. Take care.