pathology report question...

[happymom2v]

I was trying to add to my other question...but it wouldn't let me, so I am very SORRY to start another thread...

What are the chances that the HCC can come back post transplant, either in the new liver or as a metasized cancer elsewhere in the body???

Here is Pathology:
1. The trichrome stain confirms absence of fibrosis. there is no macrovesicular steatosis or necrosis.
2. The specimen reveals a 1.2cm partially necrotic subcapsular nodule in right lobe. The necrotic nodule demonstrates residual moderately differentitated hepatocellular carcinoma.

Tumor size 1.2cm,
Solitary tumor in right lobe
Tumor Necrosis: present 80%
Tumor extension:Tumor confined to liver
Hilar margin: hilar margin is uninvolved by carcinoma
Distance of invasive carcinoma from closest margin:  5cm,
Primary tumor
pT1: solitary tumor without vascular invasion
Fibrosis score: 4

Based on this pathology report...Is there a chance HCC will come back either in new liver or as a mestastic cancer?

[Thomas D Schiano, MD]

good luck--i think everything will be fine

[happymom2v]

Thank you so much Dr. Schaino. Thank you, for always answering all my questions = )

[Thomas D Schiano, MD]

i appreciate your concern but again strongly believe that you shouldnt worry about this

[happymom2v]

Thank you, Dr. I am very anxious and worried about the Pivka results. I know you said you don't know much about this test, but why did my level elevate? This is what keeps going through my mind and keeping me up at night. Pretransplant it was <2.0 and now its jumped up to 3.8. I can't help but worry if the next blood draw for the Pivka in 2 months, will show more of an increase. Of course, my biggest fear is the return of HCC.

[Thomas D Schiano, MD]

good luck

[happymom2v]

Thank you so much Dr. Schiano. You are extremely helpful. I appreciate you taking the time to answer all of my questions. Thank you.

[Thomas D Schiano, MD]

The PIVKA is not used by many transplant centers--I am sorry that i dont know a lot about it.  The DCP is also not routinely used.  The histopathology is by far the most important and predictive factor for recurrence.  I really wouldnt worry about the slightly elevated PIVKA level whatsoever

[happymom2v]

Thank you, Dr, Schiano.

What type of blood test is the "des-γ-carboxy prothrombin (DCP)"? Is this the same test as the "PIVKA II" test? Is the DCP test used as a tumor marker test?

The reason I keep asking about the PIVKA II test is...prior to transplant as well as up to 9 months post transplant, PIVKA II tests results were ALWAYS <2.0 (normal range is <6.3 ng/mL). During the 9 month post transplant visit the level was 3.8. Although this is within the "normal range", it is elevated from prior results. I worry and stress that it is indicative of HCC recurrence. How reliable is this Pivka test? Can these types of tests fluctuate?? Extremely confused as to why some transplant facilities use the PIVKA II test and others do not? I would greatly appreciate any advice. Thank you.

[Thomas D Schiano, MD]

this is correct.  Again, remember that your risk of recurrence is exceedingly, exceedingly low

[happymom2v]

Hi Dr. Schaino.

I am sorry, I am a little confused. Can you please explain for me…
If AFP was NOT elevated prior to transplant (for someone who had HCC), then the AFP test would NOT be a reliabl/sensitive test, post transplant, for someone who possibly may have recurrent HCC?

So beside CT or MRI and the tumor maker tests of AFP & AFPL3%, there are no additional tests to check for HCC?

Thank you = )

[Thomas D Schiano, MD]

correct AFP would be reliable post if not elevated pre.  Really there are no other tests to assess

[happymom2v]

Thank you.

If AFP wasn't elevated prior to transplant, then would the AFP be a reliable test post transplant?

In addition to the the scans (CT or Mri) and the AFP, are there any other tests that should be done to monitor for recurrent HCC?

[Thomas D Schiano, MD]

afp could detect recurrent cancer anywhere in the body, if it were (+) before the transplant.  Recurrent hepatitis has no impact on recurrence of the cancer.  PIVKA ll is definitely bot standard of care as i am aware

[happymom2v]

Thank you very much.

Will the AFP elevate/be able to detect if the HCC spread to another organ, (example lungs) or is the AFP test only dedicated to detect HCC in the liver?

Does active Hepatitis in the new liver increase chances of the HCC coming back?

I previously asked you about the Pivka II test...why do only certain transplant centers use this test? Is this a new and upcoming test for the detection of HCC? Or is it still a "trial/experimental" test?

Thank you again.

[Thomas D Schiano, MD]

this is a safe distance

it could go to liver or lung.  there is no specific pattern per se

[happymom2v]

Thank you, Dr. Schiano.

In the pathology report it says
"Distance of invasive carcinoma from closest margin: 5cm"
Is this a "safe" distance?

If HCC does come back, typically, does it first reappear in the liver, or could it show up elsewhere first, like the lungs, then go to the liver? Is there a specific pattern that HCC follows post transplant?

[Thomas D Schiano, MD]

we scan them every 6 months.  We get CT scaan so that the chest can also be imaged, unless the person has kidnet problems, and then an MRI is done

[happymom2v]

Thank you get much, Dr. Schiano

1. How often are Post transplant patients sanned at your facility? Especially the patients that have been transplanted due to HCC?

2. How do you determine which Post transplant patients should get an Mri and which should get a CT scan?

[Thomas D Schiano, MD]

there is no difference between MRI and CT scan surveillance.  there is not a major difference between moderate and well differentiation when it comes to recurrence.  the most important factor is absence of vascular invasion which is very good for you.  No difference between HBV and HCV regarding recurrence rate. at some centers MRI may be favored by the radiologists, etc. scanning every 3-4 months is a little more aggressive than we do at Mount Sinai.  Recurrent HCC can come back in the new liver or elsewhere, such as in the lung.  I am confident that you will be fine.

[happymom2v]

In addition to my questions above...I also wanted to add...

Cirrohsis was due to Hepatitis B. Does HCC from Hepatitis B act differently than HCC caused by Hepatitis C? The hepatitis B DNA was undetected prior to transplant. Does this also effect reoccurance of the HCC?

Thanks.

[happymom2v]

1. I am sorry if I keep asking the same question, but with a "moderately differentiated" tumor, are the chances for recurrance that much greater versus a tumor that is "well differeniated"?

2. If the HCC does reoccur, does it come back in the liver or does it show up as a mestatic cancer, elsewhere/in another organ? As you might be able to tell, I have a HUGE fear that the HCC will come back.

3. Is a CT scan every 3-4 months an aggressive followup approach?

4. Why do some transplant centers use Mri over CT scan?

5. In your opinion, which do you feel is a better scan, CT or Mri?

Thank you.

[Thomas D Schiano, MD]

frankly i dont think there is much difference between well and moderatre differentiation with regard probability of post-transplant recurrence.We screen with MRI or CT scan (either is equivalent at out center) every 6 months for the first 2 years post-transplant, as well as checking Afp

[happymom2v]

1. Because the tumor was described as  "moderately differentiated", is there more of a chance that the tumor/HCC can reappear as opposed to if it was a "well differentiated" tumor?

2.How often should a patient be scanned POST transplant (especially someone who's been transplanted due to HCC)? Which scan is preferred, an Mri or CT?

As always, thank you very much for helping me.

[Thomas D Schiano, MD]

differentiation means how far away from from normal cells the cancer--poorly differentiated is the worst.  if the portal vein thrombosis was due to the cancer they would've seen it..  There was no steatosis (fat) in the liver.  partially necrotic capsule means that the treatment you received prior to the transplant was quite successful in attacking the HCC