Is Liver Transplantation Possible for End-Stage Liver Cancer?

Is liver transplantation feasible for end-stage liver cancer?

My uncle was recently diagnosed with terminal liver cancer and was given a prognosis of only six months to live.
Is liver transplantation a viable option? However, there is a possibility that cancer cells are also present in his blood, which may indicate that there is no hope left and we can only do our best.
The doctor mentioned that surgery and chemotherapy are not options, and the only treatment available is embolization to prevent the cancer cells from spreading further.
Could you please provide a prompt response? Thank you.

Xiao Zhen, 20~29 year old female. Ask Date: 2003/12/23

Dr. Lin Zongzhe reply Oncology

Hello! Liver transplantation is currently not considered a suitable treatment option for liver cancer, especially for tumors that are difficult to resect surgically.
Surgical resection remains the best chance for a cure.
It is advisable to bring the patient's CT scans and relevant test data to seek a second opinion from an oncology specialist.
If surgical resection is not feasible, embolization therapy is currently a more commonly adopted treatment method for many patients in Taiwan.
Sincerely, Dr.
Lin Tsung-Che, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2003/12/23

More Info

Liver transplantation is a complex procedure that can offer a potential cure for patients with liver cancer, but it is not suitable for everyone, especially those diagnosed with end-stage liver cancer. In your uncle's case, where he has been diagnosed with terminal liver cancer and given a prognosis of only six months to live, the feasibility of a liver transplant is highly questionable.

Typically, liver transplantation is considered for patients with early-stage liver cancer, particularly those who meet specific criteria such as the Milan criteria. These criteria include having a single tumor less than 5 cm in size or up to three tumors, none larger than 3 cm, and no evidence of extrahepatic spread (cancer spread outside the liver) or vascular invasion. If a patient has cancer that has spread to other organs or has significant vascular involvement, they are generally not considered candidates for transplantation.

In your uncle's situation, if there is a possibility that cancer cells have spread to the bloodstream or other organs, this would further complicate the potential for a successful transplant. The presence of circulating cancer cells indicates that the cancer is systemic, meaning that it is no longer confined to the liver. In such cases, the likelihood of the cancer recurring after transplantation is significantly increased, and the procedure may not provide any benefit.

Given that your uncle's doctors have indicated that he is not a candidate for surgical resection or chemotherapy, it appears that the focus of treatment has shifted to palliative care. Transarterial chemoembolization (TACE) is a common approach used to manage liver cancer when curative options are not available. This procedure aims to block the blood supply to the tumor and deliver chemotherapy directly to the cancer cells, which can help to slow down the progression of the disease and alleviate symptoms.

In summary, while liver transplantation can be a life-saving option for some patients with liver cancer, it is not appropriate for those with end-stage disease or significant metastasis. It is crucial to have open discussions with your uncle's healthcare team to understand the best possible options for his situation, focusing on comfort and quality of life. Palliative care services can provide support for managing symptoms and improving overall well-being during this challenging time.

If you are seeking further opinions or treatment options, it may be beneficial to consult with a multidisciplinary team specializing in liver cancer, including hepatologists, oncologists, and transplant surgeons. They can provide a comprehensive evaluation and help determine the most appropriate course of action based on your uncle's specific circumstances.

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