During my appointment at Memorial Sloan Kettering, one of my goals was to find out whether I would be a candidate for any treatments that specifically address the liver. From my perspective, my liver has often been the location of disease progression and the reason that I needed to switch treatments. Of course I know that I do have tumors in my bones and lymph nodes that all of them are the same type of cancer cells. I should also note that my regular oncologist, Dr. T, has not encouraged any of these, but I needed to ask anyway. The doctors explained that the new approaches are to target cells anywhere in the body that have certain mutations, rather than going after cancer cells in one organ. Targeted treatments have fewer side effects because they spare healthy cells, as opposed to chemo which kills all rapidly dividing cells, leading to stomach problems, hair loss, etc.
We discussed hepatic chemoembolization, a process that involves putting a catheter into the liver to inject chemotherapy. Dr. Naidoo explained that it is a very toxic procedure typically used in patients who have colorectal cancer that spread to the liver and no other parts of the body. It requires an overnight hospital stay and is so painful that patients are given a morphine pump.
Two types of radiation to the liver called radiofrequency ablation and liver brachytherapy (radioactive seed implants) are sometimes used. Drs. Traina and Naidoo felt these would not be likely to lead to a major improvement for me.
The other option we discussed was liver transplant. I knew that I would never be a candidate on a transplant list, but my sweet sister was willing to share a bit of her liver with me – now that is just true sisterly love. Even if that were possible, the doctors explained that after an organ transplant I would need to take immunosuppressant drugs to avoid “rejecting” the new tissue. Those drugs would allow the cancer to run rampant throughout my body. I’m happy I asked anyway, because now I know the reason why it wouldn’t work.
The good news I got is that it is possible for the liver to regenerate itself. The areas that have been taken over by cancer won’t change back to healthy liver cells, but new liver cells can grow. Dr. Traina suggested that I focus on labs like bilirubin and liver function tests because they are a better measure of how well my liver is working than how much of my liver appears to be cancer cells on a scan. She said that even with my recent spike in AST and ALT (liver function), my bilirubin has remained at a normal level (a very good sign). Also since I stared Taxol/Carbo there has been a dramatic change in the AST and ALT numbers.