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Medical Edge Newspaper Column from Mayo Clinic
WHEN A LIVER TRANSPLANT MIGHT HELP
DEAR MAYO CLINIC: What type of cancer is not considered to be curable
by receiving a liver transplant? For a person with cancer of the liver
or cirrhosis of the liver, what are their chances of receiving a liver
transplant? — Florida
ANSWER: Cancer that has spread, or metastasized, from another part
of the body such as the breast or colon is not treatable with a liver
transplant. Such a transplant would remove the tumor or tumors in the
liver, but in these cases the cancer likely resides in another part of
the body, making the risk of cancer recurrence after transplant very high.
And once the person started taking immunosuppressive drugs to prevent
organ rejection, the cancer that remained would grow even more rapidly.
On the other hand, primary liver cancers — such as hepatocellular carcinoma
and cholangiocarcinoma — may be cured with a liver transplant. Of the
cancers that originate in the liver, hepatocellular carcinoma is the most
common. The rate of hepatocellular carcinoma in this country doubled between
1977 and 1997. That is probably related to the rise in hepatitis C infection.
The vast majority of hepatocellular carcinomas occur in people with underlying
cirrhosis (scarring).
A diagnosis of cirrhosis does not necessarily mean a person needs a liver
transplant. Cirrhosis — whether from alcoholism, chronic infection with
hepatitis B or hepatitis C, or one of the other potential causes — takes
many years to develop. Depending upon the degree of damage to the liver,
people with cirrhosis may be treated with medications. A physician should
monitor these patients to make sure no cancer develops and that they don’t
develop complications such as gastrointestinal bleeding, fluid buildup
in the abdomen (ascites), or pulmonary or renal problems.
The likelihood that a transplant center will transplant a patient with
hepatocellular carcinoma decreases if the tumor is larger than five centimeters
in diameter; if many tumors are present; or if the tumor has metastasized
to other organs, lymph nodes or has invaded blood vessels within the liver.
Once a person with hepatocellular carcinoma is deemed a candidate for
transplant, there are two immediate concerns. One is to transplant the
person as soon as possible, and the second is to try to slow down the
growth of the tumor while the patient is waiting for a suitable donor
organ.
At many centers, including Mayo Clinic, physicians may try to slow the
tumor’s growth with a minimally invasive procedure called chemoembolization.
A catheter is inserted into the femoral artery in the patient’s groin
and advanced under X-ray guidance to the blood vessel that supplies the
tumor within the liver. That part of the liver is injected with a high
dose of chemotherapy and the blood vessel that supplies the tumor is then
purposely blocked with a special material. Closing the artery to the tumors
cuts off oxygen and blood flow, causing the tumor to shrink while the
patient waits for a donor liver.
— Christopher B. Hughes, M.D., Transplantation Surgery, Mayo Clinic, Jacksonville,
Fla.
Additional Resources:
Liver Transplant
Appointment
Information
More
Information on Liver Transplants
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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