Transplantation for Liver Cancer

Question: My husband has just been diagnosed with stage II liver cancer, although the doctors say the several tumors are still small. What are our options?

Answer: Hepatocellular cancer usually occurs in an environment of chronic liver damage, which can be caused by hepatitis C, biliary cirrhosis, and, increasingly, fatty liver disease. With the rise in obesity, we’re seeing an accompanying rise in fatty liver disease. The scarring process from chronic liver injury can lead to the development of cancer.

In the standard treatment for liver cancer – liver resection – surgeons take out the cancerous part and depend on the remaining liver to regenerate. In a normal person, the liver left in place regenerates to make up for the portion that is removed. However, in the presence of cirrhosis, there is an increased chance of liver failure, since the damaged (cirrhotic) liver, usually cannot regenerate in a normal way.

Transplantation is a good strategy for these patients with early cancer because this removes the tumors and also provides a normal liver as a replacement. We can consider both liver resection and transplantation, depending on the type of cancer and presence or absence of associated liver cirrhosis.

Our team of skilled liver surgeons regularly performs both types of procedures.

In patients with cirrhosis and primary liver cancer, who are being considered for liver transplantation, we often treat them with chemoembolization — for local tumor control, while they are on the transplant waiting list. In chemoembolization, anti-cancer drugs are injected directly into a cancerous tumor, and a synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumor. This procedure prevents blood from flowing to the diseased tissue, helping the tumor to shrink.

In some cases, even more advanced stage tumors (stage III and Stage IV) will shrink enough to meet the size criteria for the transplant list. We’ve been successful in 25 percent of all Stage III and IV patients to get them to transplant with less than a 10 percent rate of cancer recurrence.

We now see this as a primary strategy for patients who wouldn’t otherwise have good options. There is a good survival advantage with chemoembolization. Patients who qualify for transplant usually receive their transplants within three to six months.