Liver Disease

[Saf26]

Dear All

My father had Hap C 6 years ago, he had the treatment and it went negative. Recently he has been diagnosed for liver cancer (HCC). It is a primary cancer (15cm), the doctor advised to do TACE and embolisation before doing the surgery. We had a scan on 3/2/14, the tumor size was small which was a good thing, but AFP level gone up. It was 30,000 in December 13 blood test, increase to 50,000 on 23/1/14 test and then increase to 150,000 on 3/2/14 test. The doctor expected it to go down after TACEand embolisation. We are now very worried and concerned. Can anyone help please.

[Thomas D Schiano, MD]

there is no specific data on its use in this setting but I think there is little downside to its use.  It can be at times difficult to tolerate at higher doses

[Saf26]

Hi Thomas
The doctor has now suggested the following to an Oncologist:

'I would be most grateful if you would see the above-named patient who has presented with a large right lobe hepatocellular carcinoma on a background of hepatitis C.  He has undergone transarterial chemoembolisation and we have seen his alpha-fetoprotein climb from 50 to 130,000 kIU/L.  He seems to have had significant Lipiodol deposition, so we are hopeful that this does represent a response.  However, I would be most grateful if you could review him to assess his suitability for Sorafenib.  The plan is for him to undergo a second cycle of transarterial chemoembolisation'

Do you think Sorafenib is an option?
Thanks

[Thomas D Schiano, MD]

they need to be aggressive with the chemoembolization. if the AFP doesnt respond to this treatment then unfortunately the surgery may not be curative and then it could potentially delay further ongoing treatements

[Saf26]

Hi Thomas
ALT increased from 110 to 121 between 23/1/14 to 3/2/14.  AFP level increased from 50,000 to 129,000. The doctor now concerned on the rise and advised that the tumor is very aggressive and surgery is not an option at that time as there is a chance of recurrence. He suggested to have another chimo embolisation and also take medicine to kill the tumor.  He has seen the CT scan and confirmed that Tumor is still primary, they couldn't find any where else. We are very concerned that the first Chimo embolisation didn't help to decrease AFP and if we delay surgery, tumor may spread. What will be the benefit of another chimo. Please help.

[Thomas D Schiano, MD]

this is a possibility but frankly i am concerned about bthe tumor burden.  resection is probably the best overall option.  If the AFP rises from the chemoembolization, the ALT will also be higher

[Saf26]

Dear Thomas
Thank you for your comment.
The doctor in London is planning to do the resection through surgery once the right side of liver is shrunk. The doctor had suggested that the rise in AFP may be due to the chimo embolisation done 3-4 weeks ago, it may take time to come down. Do you think he is doing right? Is the rise in AFP temporary.

[Thomas D Schiano, MD]

if the HCC is 15 cms then the only treatment is aggressive locoregional therapy.  radioembolization with Y-90 is another option.  I share your concern as the AFP should decrease with treatment--the rise is suggestive of some occult disease or portal vein involvement