"more transplants urged for liver cancer"

[arlo 0]

(edited for clarity)

in a nutshell: clinical studies have found that people receiving a liver transplant during stage 3 hepatocellular carcinoma (liver cancer) have 5-yr surgical outcomes as good as people who have had a liver transplant due to reasons other than liver cancer. so if you know someone that has liver cancer for whatever reason, give them this article. most clinics will only transplant stages 1 or 2, so you may have to put your head down and push. it's better than not doing anything at all.

blues,
arlo

p.s. this came out last month but i missed it.
=====================


Review
ST. LOUIS, May 16-Five-year surgical outcomes for patients with stages I to III hepatocellular carcinoma seem equivalent to those of non-cancer patients, a finding that may open liver transplantation to more patients.


In a study by investigators at Washington University here, only those patients with stage IV disease had poorer post-transplant survival, Jeremy Goodman, M.D., and colleagues reported in the May Archives of Surgery.


"The present study confirms the success of transplantation for hepatocellular carcinoma in early-stage disease, and adds to the growing body of evidence that stage III disease may also be successfully managed with transplantation," wrote the Washington University team.


Although early experience showed a less than 50% one-year survival rate among patients with liver cancer who underwent transplantation, a team at Italy's National Cancer Institute published data in 1996 indicating that liver transplantation could be effective at treating small, unresectable hepatocellular carcinomas.


Those patient selection criteria essentially limited the procedure to patients with stage I or II disease. The guidelines, dubbed the Milan criteria, were subsequently adopted by UNOS, the United Network for Organ Sharing.


Currently, the five-year survival rate following transplantation in patients with hepatocellular carcinoma is 61.1%, "which is presumptively attributed to improved patient selection," the St. Louis team wrote. "Furthermore, there are now reports of success after transplantation in individuals whose tumor burden exceeds the Milan criteria."


To test this idea that patients with stage III might do as well as those with less advanced cancer, or even as well as matched patients without cancer, the investigators looked at a cohort of 51 adults with cancer out of a series of 635 who underwent liver transplantation at their center over a 17-year period. They compared the results with those of 153 matched controls without cancer who also underwent transplantation there.


Median five-year survival for all patients with hepatocellular carcinoma (stage I-IV) was 48%, compared with 65% for controls (P = 0.7). But when patients with stage IV disease were excluded from the analysis, the five-year survival rates were not statistically different between the patients with or without cancer. Among patients with stage III disease, the one-, three- and five-year survival rates were 78%, 78% and 65% respectively. In comparison, the survival rates for non-cancer patients were 74%, 63%, and 59% (P = .44).


In contrast, one-, three- and five-year survival rates for patients with stage IV disease were 59%, 29%, and 26%, respectively.


"This retrospective review of our experience with liver transplantation for hepatocellular carcinoma supports the use of this treatment modality for patients with early-stage disease," the authors wrote. "Furthermore, patients with stage III disease had outcomes similar to those with less advanced malignancy as well as to non-hepatocellular carcinoma matched controls. On the basis of these findings, we support the expansion of special priority for liver transplantation to those with stage III hepatocellular carcinoma."


They acknowledged that the study did not look at the possible effects on outcome of pre-transplant adjuvant therapy, and that the retrospective case-control design means that controls might not be well matched to cases.

[IanHarrop 43]

Quote

clinical studies have found that people receiving a liver transplant during stage 3 hepatocellular carcinoma (liver cancer) have 5-yr surgical outcomes as good as transplanted people that do not have liver cancer.

So if they didn't have cancer why did they get a transplant? I'm confused???

Or did I read it wrong... "as good as transplanted people" Does this just mean the people were moved (tranplanted) from one place to another?

"Where troubles melt like lemon drops, away above the chimney tops, that's where you'll find me" Dorothy

[Lindsey 0]

Quote

Quote

clinical studies have found that people receiving a liver transplant during stage 3 hepatocellular carcinoma (liver cancer) have 5-yr surgical outcomes as good as transplanted people that do not have liver cancer.

So if they didn't have cancer why did they get a transplant? I'm confused???

Or did I read it wrong... "as good as transplanted people" Does this just mean the people were moved (tranplanted) from one place to another?

cirrhosis

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[arlo 0]

hepatitis C accounts for the largest percentage of liver transplants. other liver diseases come in behind that. livers infected with hep c can also progress to cirrhosis (another reason for transplant) and then hepatocellular carcinoma.

if cancer is found in the liver of a hep c patient, then the transplant is totally dependent upon the progression of the liver cancer. if it is "only" a small spot then they may transplant. if it is infiltrated into more than some percentage of the total liver volume or located too close to the portal vein, they will not perform a transplant.

what this article is saying is that where before, they'd say no, now they are saying it's possible.

so short story long: cancer of the liver is usually a DETERRENT to receiving a liver transplant. liver disease is the major reason why transplants are performed.

hope this helps you understand a little better. sorry it wasn't more clear. :)

arlo

[JohnMitchell 16]

Thanks for the info. That kind of information is power when dealing with the medical establishment. I have a feeling some doctors (mostly the not so good ones) must hate the internet. We've used it many times in our family to research into things that the doctors want to gloss over.

[Lindsey 0]

Quote

Thanks for the info. That kind of information is power when dealing with the medical establishment. I have a feeling some doctors (mostly the not so good ones) must hate the internet. We've used it many times in our family to research into things that the doctors want to gloss over.

But, unfortunately, there's also a lot of WRONG medical information on the internet, but once some people read it they believe it no matter how many ways you give them correct information. It is nice that people, who want to improve their understanding have easy access to some good information too. You just have to know where to look.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[JohnMitchell 16]

But it's on the internet. It must be true!

Very good point. You have to consider the source. It's been a priceless tool for our family, though.

[arlo 0]

Quote

But, unfortunately, there's also a lot of WRONG medical information on the internet, but once some people read it they believe it no matter how many ways you give them correct information. It is nice that people, who want to improve their understanding have easy access to some good information too. You just have to know where to look.

this is very true. it's up to us to research and verify information that is put out. i learned an incredible amount of information pertaining to liver disease from some of the top specialists in the world (mayo clinic jacksonville, gastroenterology/hepatology dept) when my mother was diagnosed with hep c in late oct 98. she died in august of 99.

those guys (and the mayo clinics) are just off the hook. as of oct last year, they have performed over 1000 liver transplants since the recent inception of the transplant dept in feb 1998. they had the transplant time down to 3.5 hrs according to dr steers (who is the director of transplant services there). these guys know there shit and they were happy to feed me as much info as i could possibly absorb because i took a proactive stance and made myself knowledgeable about the disease and the options.

anyway, i just wish people knew how much of a difference they can make by becoming involved in their own healthcare of the health of others. i've included an article below regarding the mayo clinic and their incredible achievements the past few years. i would HIGHLY recommend these guys to anyone.

blues,
arlo

=====================


Mayo Clinic in Jacksonville

Monday, October 25, 2004

A Jacksonville milestone: 1,000th liver transplanted at Mayo Clinic

Additional Resources

For appointments or information, call the Transplant Center at
(904) 296-5876 between
8 a.m. and 5 p.m.
Eastern time, Monday through Friday. E-mail: livertransplant@mayo.edu.

Learn more about Mayo Clinic Jacksonville:

Becoming a patient

Department of Transplantation Services

Liver Diseases and Transplantation Program

News releases




JACKSONVILLE, Fla., Oct. 25, 2004 -- Mayo Clinic surgeons marked a special milestone in the operating room at St. Luke's Hospital yesterday when they completed the 1,000th liver transplant in a program born less than seven years ago.

The patient is a 26-year-old woman who suffered from cholestatic liver disease. She is doing well and recovering in the hospital's Liver Transplant Unit.

When the liver transplant program opened in February 1998, 15 transplants were projected for the first year. Instead, the team transplanted 54 livers, and the program has been breaking records ever since. Only 16 out of 122 active liver programs have reached the 1,000th transplant milestone.

Today, Mayo Jacksonville's liver transplant program is among the top five in the country and the largest in the Southeast based on annual number of transplants.

The median waiting time to transplantation at Mayo Clinic is the shortest in the nation at just 1.7 months.

For example, in 2003, 171 liver transplants were done at St. Luke's. Typical liver programs in the country transplanted between 16 and 67 people in that same period, according to the Scientific Registry of Transplant Recipients (www.ustransplant.org).

Experience, skill, teamwork and a willingness to evaluate every potential donor have led to the program's growth and success.

"Our program's success is due to the steadfast dedication of our team," says Dr. Jeffery Steers, surgical director of the Mayo Clinic liver transplant program. "The level of service we provide to our patients and organ procurement agencies in terms of our availability and responsiveness falls in line with our commitment to our patients. It takes a tremendous amount of sacrifice in the personal and professional lives of everyone associated with this program."

Mayo Jacksonville transplant surgeons have been at the forefront of innovative procedures, including multiple-organ transplants and the rare domino transplant, where a diseased but functioning liver from one critically ill patient is transferred into another while the first patient receives a donated cadaveric liver.

Yet patient survival rates at St. Luke's liver program are better than predicted. Registry data show that 88.23 percent of St. Luke's liver transplant patients were alive one year after transplant, compared to an expected 85.4 percent based on the patients' characteristics. The national average is 86.37 percent. Mayo's 3-year patient survival rate is the highest of all liver programs in Florida, Georgia and South Carolina.

Patients with chronic, progressive liver diseases such as hepatitis, an inflammation of the liver, are candidates for transplantation when no other effective medical or surgical treatments exist. In 2003, 5,671 liver transplants were performed in the United States, but the need for donated organs far exceeds the supply. More than 17,000 Americans are currently waiting for a liver transplant.

In addition to liver transplantation, Mayo Clinic in Jacksonville offers bone marrow and all other major solid organ transplantation: heart, lung, kidney and pancreas.

Mayo Clinic, with sites in Rochester, Minn.; Jacksonville, Fla.; and Scottsdale, Ariz., is the largest provider of transplantation in the country, performing more than 1,000 transplants annually.

[kbordson 8]

Quote

Thanks for the info. That kind of information is power when dealing with the medical establishment . I have a feeling some doctors (mostly the not so good ones) must hate the internet . We've used it many times in our family to research into things that the doctors want to gloss over.

Not true.
(Now will begin a stomping little rant - but you should have been expecting it....)

I think you need to take a poll of the medical community (establishment?!) before you try to bias the general population against them by broadcasting what they hate or not.

The internet can be a wonderful source of info (like lindsey said)... but the problem is that it can have misinformation as well and when people come in with attitudes that just cuz they "read it on the internet" it must be true or have suspicion toward the doctor who might want to truly educate without speaking "medicalese" as if he/she is just trying to "gloss over" the info, it does get frustrating. I have had women tell me that despite the distended belly that has kicks, they can NOT be pregnant because they used the coke douche or the guy that thought that if his girlfriend didn't cum, she couldn't get pregnant (nice partner, huh?). But his logic was that the "juices never mixed" and so no pregnancy. Trust me.... the misinformation is out there!!
Additionally, an adversarial attitude is not conducive to a good relationship with your doctor. And that tone might be what would shut down the teaching that they should be doing during the visit.... (or the HMO requirements of so many patients/hour)
I'm not saying that doctors are saints and care about every single patient as if she is his/her own mom... and I might be overly idealistic, but most go into the field to help people.... (except House MD... I love that show.... he gets to say what is sometimes thought....)
Anyway... end little rant now.

Karen

p.s. arlo - good information!

[ChrisL 2]

My father had a liver transplant 3 years ago due to advanced liver disease, the cause of which was never diagnosed. Hep C was suspected, but never proven

The biopsy on the diseased organ revealed the presense of Hepatocellular carcinoma.

The hope was that they had transplanted him before the cancer had a chance to spread.

Sadly 14 months ago, they found the cancer HAD in fact spread to several other areas. Once metasticized, this cancer is incurable with a 100% mortality rate.

In spite of a lot of different experimental treatments and a lot of standard ones, he passed away 10 days ago in Salem, Massachusetts 3 years after receiving his new liver.

__

My mighty steed

[kbordson 8]

Sorry for your loss, I hope that you and he had the chance to enjoy the three years that he had after the transplant.

May you have lots of support during this time.

Karen

[JohnMitchell 16]

I can appreciate your points. You must consider the sources that you use for research. But when you have nurses and family practitioners that have never even heard of your ailment, when you've had doctors tell you that it's all in your head, when you've been told that you just need to live with the pain, there's nothing to be done, then you need to take charge of your treatment. That's been our experience in dealing with my wife's lupus. I don't believe that any doctors are out to hurt anyone, but just the variance in professional opinions is enough to make you want to research things on your own.

It sounds as if you work in the medical field. I didn't mean to disparage your profession. It's just that I've been condescended to by too many doctors. I've been told not to worry about things, not to read up on things. Why?

[kbordson 8]

Lupus is a bad disease. One that is often misdiagnosised. It presents in many varied ways and sometimes waxes and wanes.... My stepdad has it and it's taking his mind. I'm sorry that you have to deal with the impacts with your wife. And it's disappointing to hear you were given a difficult time with the medical care that you and her have received.

But.... if you do "real" research then the doctors should appreciate it. By real research, I mean doing a pubmed search www.pubmed.com and finding answers to questions specific to your condition or current studies showing new techiques for dealing with the disease. But don't just go to any website and take the answers as fact (a good hint is that if it has a popup or a link to some miracle pill.... then take it with a grain of salt) Sometimes people are too willing to believe what they want to hear which means that even if it's misinformation they will cling fast to it. But.... that all being said - You shouldn't have been told not to read up on things.... that I find odd for someone to have told you. (not that they didn't.... just an odd thing for them to say)

Anyway.... I wish you and her well. (and keep doing the pubmed searched, cuz someday we might have better meds or cures for lupus. Autoimmune disease suck)

Karen

[Lindsey 0]

Another issue with information that patients and families get on the internet is that they tend to get a very simplistic view of very complex problems. For example, a friend's elderly mother had a stroke sometime in the night, and when he took her to the ER she was not given TPA (given sometimes to improve outcomes for people who have a stroke). He is a highly intelligent, educated person who simply does not have medical education. But he knew about TPA and expected that his mother should be given this medication so that it might "reverse" the stroke. TPA, while sometimes helpful, if given to the wrong patients actually increases mortality. Now all of the information about the pharmacology, why it might work for Joe while it worsens Sue's condition, the risks vs. benefits of the drug, etc., are not things that the average person getting information off of the internet is going to really understand. Meanwhile, the average person (even above average person) DOES understand that TPA might help my mother. With THAT understanding, the family member demands that his mother be given the medication and threatens lawsuit if she isn't.

So even when information isn't actually misinformation, what's given on the internet often doesn't tell the whole truth, and if it does tell something close to the whole truth, patients and family members usually do not have adequate knowledge of medicine to apply it correctly.

It's like the "Ask your doctor about (fill in the blank) drug." It's great to ask your doctor about this or that medication, but there are very good reasons that a physician might prescribe X medication overy Y medication for your, say, hypertension. And since most patients do not have a medical background, it's really difficult to give a good explanation of why Y medication may not be the best choice...other than just glossing it over with a "research shows....." type of answer. Because most people have no idea how renin and angiotensin work, or how beta adrenergic system works, or how calcium channels work, or how this diuretic works differently from that one, or why among different populations one might be better than another.

It's wonderful when people actually want to be involved in their health care, and the internet does have some really good information here and there. It is important to know where to look, but it's equally important to recognize that even good information doesn't usually provide a person with all of the information needed to make good medical decisions.

In my experience so far, doctors (for the greatest part) do what they think is best for their patients and REALLY do give their patients' conditions a lot of thought. Most things in medicine aren't cut and dry, though, and three excellent physicians may come up with five different alternatives to treating the same set of symptoms. Then we could get into what is involved in a Differential Diagnosis, and why different physicians might tentatively call a set of symptoms one thing while another calls the same set of symptoms another, but that'd open a new can of worms....though a very similar one.

Peace~
linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail