First visit to the Transplant Center & Learning about TACE | yosoyrosa's Blog

Yesterday while I was at work, I got the call that an appointment was setup for us to go to the university hospital and meet with the doctor that has been reviewing our case.  Later in the day I received a text message that we also had an appointment setup for the next week for the first localized chemo treatment.  Here we were within 48 hours, getting diagnosis to scheduling treatment, and we had a number of open questions.  I realize that I say 'us', 'our' and 'we' as my husband and I are together, sharing a common bond of fear and wonder at how fast our lives have changed.

 This morning we headed out by train to the city, and after taking a cab to the university hospital, found ourselves staring at the plaque on the door and two words stuck out "Transplant Center", room 805.  It only took a few minutes for us to be introduced to a lovely woman named Sherrie that was to be our coordinator.  Confirming we had her contact information, she briefly explained that she worked very closely with our doctor and that we were to use her as point of contact for procedural questions, and overall what is next etc.  She handed us our new patient profile form, and led us to the conference room where we had just a short time before we would be with the doctor.  

The form was several pages long, and started with phone/fax of our local pharmacy, emergency contacts, current GP name/address/phone, current GI name/address/phone, and many background medical questions.  The first time we visited a doctor at the university I had brought the folder with all my facts together and case files together.  This time I was resigned to best effort between us for accuracy.

The doctor came in shortly after, and led us to the patient room to review our case and current status.  There were a number of items to think about:  

• The TACE procedure is localized treatment, and you’ll stay overnight.
• The TACE may only be one of a few in fact. If there’s more than one lesion treating all of them at once is sometimes not the most prudent thing just because the team wants to just assess things and make sure that your liver tolerates it well.  
• What they’ll do is an angiogram.  They’ll go in through the groin the way they do a cardiac cath but instead of going up to the heart, they’ll go to the liver.  They will inject dye and find where there is basically an area that looks like a tumor blush, where there is vascularity from a tumor
• They’ll cut off the blood supply to that and also inject some chemo.  Now the chemo tends to stay in the liver, it doesn’t tend to cause a lot of side affects.  Some people do get a little bit of nausea, some people get pain and that’s from basically killing the tumor and rim of surrounding liver tissue.   
• The Dr will talk to the team and look at the angiogram.  If they said “you know what, we definately need to treat again”  they’ll schedule that for a couple weeks later or three weeks later.  Then if necessary treat it again.  When they’re satisfied that they’ve treated things well, we’ll get a cat scan three or four weeks later.  And we have to wait that long, we can’t get it right away ‘cause that’s really the time point knowing if there is still residual tumor or not.

So the procedure is generally very well tolerated, they do tons of these, all the time and we can expect to leave the next day.  We'll go home on some meds for pain but its really unusual for people have to stay an extra day because of belly pain or the lab tests are up.  

What about seeding?  Seeding is from sticking something through the skin and dragging sample cancer cells out that form new tumors.  For part of the procedure there’s a risk but its pretty small.  

Will my hubby go bald?  What about Chemo Sickness?  Its variable, some people don’t have a lot of symptoms, some people have nausea, vomiting, for a couple days then maybe pain for up to a week.  Some people have low grade fevers, that’s usually from the tumor necrosing basically, or its dying.  Compared to the interferon & ribivarin effects, this ain't nuthin!

In our case, there was no vascular invasion that they could see.  It actually, it usually doesn’t go into the arteries and doesn’t go into the bile ducts, it goes into veins, to the veins that are usually entering the liver, the portal vein, and things and thats the way the tumor likes to grow.  If they see cancer in the vein structure, it is obviously its a bad, bad news.

Sorafenib is this medication that is FDA for advanced cancer that could also be part of treatment. This is a pill that you take twice a day and kinda slows the tumor down for early stage patients, it doesn’t kill much of the tumor but it prevents it from growing by stealing its signaling pathway that tumors use to grow.  This medication is being introduced to try and bridge people to transplant, preventing the vascular invasion.

After just a few minutes more and several references to the online article about the disease and procedure, the phrase of the day was established:  Transplantation is our only curative treatment option.

For anyone that wants information about Hepatocellular Carcinoma and treatment, here's the link to the article the doctor referred to:

http://knol.google.com/k/tim-davern/hepatocellular-carcinoma/4ptrsx4j4vcq/2# 

Another really good one created in dedication to those infected with Hepatitis C:

http://liversociety.org/index.html

The American Cancer society is always a resource:

http://www.cancer.org/docroot/home/index.asp