HCC and biopsy/alternatives for dx

[rivll]

I was recently diagnosed with HCC after a ct scan showed a 3.0 by 3.6 lesion in the upper right quadrant of my liver. Even though a biopsy wasn't performed, my Hepatologist, along with the Tumor Board determined it was malignant by the shape. It was near the hepatic vein so they acted quickly and I had the TACE procedure. Next week I have an MRI to determine whether the procedure was effective.
It is my understanding that even if the tumor is no longer present I will need a liver transplant as it is certain to return.The procedure was to buy me time.
My question is since there is no physical evidence of malignancy how can we be certain that it is HCC ?
My AFP was 18. I was cured of HCV last year but I have cirrhosis, though before the lesion, my MELD was only 6 and my labs are normal.In addition to that my sister died at a relatively young age of HCC.
With my history and my excellent Hepatologist I realize it is likely that I do have a malignant tumor, but it seems to me that if I am to have a transplant it would be worth getting documented evidence of cancer beforehand.
I appreciate your thoughts on this matter.

[Thomas D Schiano, MD]

sorry for the late response but there has been a problem with the server.  i agree with mike.  We are seeing more and more cases of HCC developing in patients after having been cured of HCV.  You should accrue waiting time on the list (for instance in NYC it takes 9-12 months to accrue enough waiting time to be transplanted).  upon repeat imaging if there is no overt tumor you do not need to proceed with transplantation and will not be penalized for it.  remember that it is only a minority of HCC that are cured with locoregional therapy.  good luck

[rivll]

Thank you, I hadn't realized that if the tumor does not return I will not need a transplant. I know it is unlikely, but it does give a bit of hope.

Thanks much.

[rivll]

??

[Thomas D Schiano, MD]

testing response system

[rivll]

I appreciate your input. I was actually going to send you a pm with the same question!! lol

Yes, I do trust my Hepatologist. He acted quickly and aggressively against the tumor and I do believe he and the team are on the right track.
I just didn't get why there was no biopsy and you explained that well. Thanks Mike.

[mikesimon]

I apologize. I didn't realize that this was the Expert Forum and had I known that I would not have weighed in.

Mike

[mikesimon]

While your hepatologist may not be able to say with absolute certainty that your tumor is malignant I assume that there is a very high degree of confidence that it is. It is greater than 2 cm, it is in a setting of cirrhosis post HCV and the imaging studies are showing HCC characteristics. While your AFP is rather low for a patient with HCC the rest of the diagnostic criteria trump a low AFP.. I think it really depends on the level of confidence you have in your doctor and in the liver transplant program. Sometimes we have to trust our doctors and you may be in that situation now. I assume that if a biopsy was easy and not too risky one would have been performed already. Really, the use of a liver biopsy in the diagnosis of HCC has diminished over the years and imaging studies have become more important.
I can understand your desire for 100% certainty and I'd want that too if the risk didn't outweigh the benefit. But I think in your situation you'll probably  have to trust your doctor on this issue.

Good luck,
Mike