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    Suggest treatment for liver cancer

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Posted on Tue, 2 Dec 2014 in Liver and Gall Bladder
Question: My 66 year old brother has been diagnosed with a an inoperable liver tumor that is isolated to the liver. It cannot be removed because the good liver is below 33 percent. They are going to radiate it in an effort to shrink it and grow the good part. Why is he not eligible for a transplant?
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Answered by Dr. Suresh Raghavaiah 13 hours later
Brief Answer:
Age and Size of tumor may be a factor

Detailed Answer:
Hello Mr XXXXXXX

How are you? Thank you for writing to HCM today. I hope to answer your question today. I am so sorry to hear about your brother's diagnosis.

The treatment of liver cancers depend on a variety of factors, the most important ones being the physical fitness of the patient and the condition of the remnant liver. Aggressive resections are usually limited to patients in good health and whose liver is other wise normal. In such patients a resection of upto 80% of the liver to remove the tumor is well tolerated by the patient. But if the underlying liver parenchyma is not healthy due to any reason (hepatitis, fibrosis, cirrhosis, etc), then more conservative approaches are normally advised. One exception is a Liver transplant which is offered to patients in otherwise good health but with damaged liver functions (cirrhosis). But there are very strict criteria used to assess the tumor when considering a patient for a transplant. The two most common criteria used are the "Milan Criteria" and more rarely the "UCSF Criteria". Both of these essentially have different cut-offs for the total size of tumor (6 cm and 8cm), but both state that there should be no invasion of the tumor into a blood vessel (Portal vein or hepatic veins). It is the invasion of the blood vessel which most often makes a patient ineligible for a liver transplant. The logic here is that, once the tumor invades a blood vessel, there are chances that tumor seedlings are already present and spread all over the body which are not visible by current imaging techniques. If these patients are transplanted, then the chances of early aggressive, recurrence of the tumor is very high. This is the reason most transplant centers across the world (especially where cadaveric organ transplants are done) make a patient in-eligible to be on the transplant list. Also, as a general rule, most centers across the world have a cutoff age limit of 65 years for a transplant, exceptions being where the patient is in excellent health other wise.
So in your brother's case, the few possibilities might be due to his age, size of tumor,or possible presence of blood vessel invasion of the tumor on imaging.

TARE (I hope this is the treatment being offered to your brother), does have good tumor shrinkage rates. If the tumor does shrink, then possibly, some centers may consider your brother for a transplant, although with the caveat that the post operative results may not be as good as those done for other conditions.

Hope this helps and hope your brother starts to feel better.
Please do not hesitate to write back for further clarifications (esp with imaging reports if available)

Have a great day
Dr Suresh Raghavaiah



Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Suresh Raghavaiah

Gastroenterologist, Surgical

Practicing since :2003

Answered : 164 Questions

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