Expert: Claes-Gustaf Nordquist, M.D. - 10/23/2007

Question
QUESTION: Case History:

-Female patient, 32 years old, married 2 years ago, p1+0, delivered by C.S, lactating, began to feel pain in right hypocondrium 7 months ago- severe pain associated with periodic vomiting.

- Ultra sound and C.T. on February 2006 revealed that there are multiple focal lesions in the right lobe of the liver; the largest was 2 cm in diameter. It was diagnosed as liver querey haemangiomas and the fact that the tumor marker CEA was elevated was overlooked.

-Recent ultrasound and CT (Abdomen AL and pelvic) on Sept 16, 06 reported the following:

-Multiple hepatic focal lesions, the largest one is about 8 cm in diameter, hypodense, occupying subsegment V, and their pattern raises the possibility of metastatic deposits.

Diagnosis:

-Adenocarcinoma Grade II with moderate differentiation in ileocecal (IC) junction diagnosed by colonoscopy with multiple biopsies from the suspected lesion.

-Liver metastasis scattered in left & right lobe of the Liver with the largest being 8 cm in G. diameter.

-Liver enzymes are slightly elevated.

-No enlarged lymph nodes (abdomen and pelvis PT).

-No other metastasis detected by Plane X-Ray.

-General condition very well; no change in appetite and no change in bowel habits.

Tumor Markers

CEA        =3000
CA 19.9  =75
LDH        =700

Suggested surgical intervention:

Surgical resection and anastomosis in intestine associated with partial hepatectomy with intraoperative radiofrequency; ablation after exclusion of laparoscopic staging.

Objective:

* Knowing what other suggested methods of treatment in such case.
* Prognosis of this case and survival rate


ANSWER: No objections to treatment plan except that chemo therapy (including intraarterial - arteria hepatica - or intravenous - vena porta - chemo therapy directed directly to the liver) should be added. Arterial occlusion of arteria hepatica, at least temporarily, could also be considered. Otherwise no further suggestions. Prognosis most probably not good with very bad long term survival rate very probable, but in view of her age etc. I think that no effort should be spared here! Please do keep me posted! I'm sorry to read about her situation and wish her my very best wishes!


---------- FOLLOW-UP ----------

QUESTION: Doctor,
About 6 months ago my sister had surgery to remove the tumor from the colon and it was successful. The liver (secondary) tumor has spread all over the liver. Additionally she has a (Low Fistula) that causes lots of pain due to infections. The question I have is Liver Transplant an option if we have a donor and the cancer is confined to the liver? Please advise...

Thank you and have a great day,

Ahmed

Answer
I do agree with the previous answer you have received. I'm sorry to read about her & your problems! Since her cancer has spread to her liver it is most probable that it also has spread elsewhere even if not detected - perhaps not even detectable - yet. A liver transplant would therefore hardly solve her problems. Besides, a transplant would make immunosuppression necessary at least to some extent. That is hardly a good idea when an invading cancer is involved. I therefore do not think that such a transplant would be of any value here unfortunately.