April 2, 2011 Current Status and Next Steps

On Thursday, I met with my PA and one of the surgeons. I also talked with my PA again on Friday. It turns out that I misunderstood the previous info about the cancer, due in part to my PA’s lack of knowledge in the area. There is something called the Milan Protocol that is used for transplantation guidance. From what I now (think I) understand, this guidance says that if you have more than two occurrences of cancer, you cannot be transplanted until you meet the guidelines. The guidelines are two occurrences of cancer or less and tumors that are 5 cm or less. In addition, the cancer must not have metastasized. The Protocol was developed to lessen the chances for recurrent cancer in the new organ or even other organs.

Three stains of “random” adenomas were sent to pathology. It was determined that all three stains had cancer. They sent an additional three samples to pathology, and these came back Friday morning. All three of these stains had cancer, as well. This confirms that I had multifocal hepatocellular carcinoma. Apparently, all of the adenomas had presented as adenomas in the MRIs, and there was not enough change in their appearance for a radiologist to have caught the changes. The largest adenoma was 10 cm (about 4.5 inches). So the sum and total of this information is that they absolutely would not have transplanted me because I was way outside the criteria of the Milan Protocol; they would have treated me for the cancer first and then transplanted me…IF and only if I was able to eventually meet the criteria. My PA would not come out and say it, but I was left with the impression that even with treatment, I would not have been able to meet the criteria of the Milan Protocol and I would not have been transplanted. I believe this means that I likely would have died.

This is why it is so important that I live and thrive. I need to show the transplant world that under certain circumstances, transplantation can indeed be a viable treatment option for others like me; others who have cancer that exceeds the Milan Protocol where the cancer is contained and encapsulated with no signs of vascular invasion.

I was told by the surgeon that XYZ did a pilot study with a low-dose, chemotherapy drug called Nexavar used to treat certain types of cancer. After one year, only a handful of patients who took the Nexavar (a pill) for a year had a reoccurrence of cancer; whereas 75% of patients who didn’t take Nexavar had a reoccurrence of cancer somewhere in the body. XYZ and 12 other transplant centers are now doing a larger study. In the interim, I am of course going to be put on Nexavar for a year. I am told that the side effects are usually minimal, but some of the more common ones are fatigue (great), hair loss (fabulous) and hand and foot disease (peeling of the fingers and toes…no comment). It’s only for a year, so I’ll of course suck it up.

My PA and I still both feel very optimistic since the cancer was contained, and again, there was no evidence of vascular invasion (meaning that there is no evidence that the cancer had a chance to escape and spread). My USU hepatologist feels similarly. I have to go back to XYZ next week to go through a learning process with the Nexavar. The following Thursday, I have to have my quarterly abdominal MRI, followed by a lung scan in June.

My PA took me off of my blood pressure medication (Nefedipine) to see if that helps the edema I’ve been battling for the past month. I will stay off the meds if my pressure stays below 140; otherwise, I have to take Metropolol, a beta blocker. My 90 day mark happens on April 5, which means I get to drop several of the drugs I’m taking, which is great.

I don’t think I have to tell you all that I am SO OVER the drama. Hopefully I won’t have anything new to report other than how well I’m doing on the Nexavar. As always, thank you for all the love, support and prayers.