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Patients with cirrhosis are at an increased risk of developing hepatocellular carcinoma, also known as hepatoma.  These are primary liver cancers involving the liver.  They need to be differentiated from metastatic liver cancer, which indicates the cancer is first located in a distant site outside of the liver.  Common cancers that metastasize to the liver include breast, colon, and lung.  These specific cancers are not considered for liver transplant. 

Because the risk of developing liver cancer significantly increased in patients with cirrhosis, especially those with chronic hepatitis B, chronic hepatitis C, alcohol-related cirrhosis, fatty liver disease with cirrhosis, and hereditary hemochromatosis, patients with cirrhosis need to undergo surveillance screening for liver cancer at least every six months with an ultrasound of the liver and a blood test called alpha-fetoprotein.  Alpha-fetoprotein (AFP) is a tumor marked, which is elevated in most cases of hepatocellular carcinoma. While alpha-fetoprotein is elevated slightly in many forms of chronic liver disease, was more important is to see arise and alpha-fetoprotein values compared to prior values. So it is not the absolute alpha-fetoprotein level, but rather the change that is seen in, and the rate at which a changes.

Should a tumor be suspected based on an imaging study (ultrasound, MRI, or CT scan) or the alpha-fetoprotein is elevated, based on the size and location, liver transplantation should be considered 

In most patients with cirrhosis, the identified liver cancer cannot be surgically resected.  This would typically cause serious, potentially life-threatening complications, including hepatic failure and death.  Instead, patients are evaluated for liver transplantation, as well as evaluated for some form of local therapy for the tumor.  This may include trans-arterial chemoembolization (TACE) or radiofrequency ablation (RFA) of the tumor.  For larger tumors, Y-90 radiation therapy may be considered. Medical therapy with Sorafenib, a medication taken orally, may also be considered as part of a comprehensive treatment plan. All of her patients with hepatocellular carcinoma will be managed by a multidisciplinary team, including your primary hepatologist, liver transplant surgeon, and oncologist.

In patients that present with hepatocellular carcinoma where the size is between 2 and 5 cm, with no evidence of any spread outside the liver, or without any invasion into any of the blood vessels in the liver, liver transplantation would be considered.  Patients with hepatocellular carcinoma being evaluated for liver transplant are given additional MELD exception points, affording them a theoretically shorter time on the liver transplant waiting list.

While the patients are on the liver transplant waiting list, they will continue to undergo vigorous surveillance for any change in status of the tumor, or looking for any evidence of spread.  Unfortunately, there are cases where the tumor enlarges beyond an acceptable size and they would have to be removed from liver transplant consideration.

Survival for patients with hepatocellular carcinoma that are transplanted has excellent one, three, and five-year survival compared to those without liver cancer.

Obesity and Fatty Liver Disease

Obesity, and all of its related complications, is more serious than most adults in America believe. More than one-third (34.9% or 78.6 million) of U.S. adults are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, fatty liver disease, and certain types of cancer, are some of the leading causes of preventable death. We are seeing an increase in the number of young children and adolescents developing obesity, and all of the related complications.

The cost of obesity is staggering, with annual medical cost of obesity exceeding $147 billion in 2008 U.S. dollars. The medical costs for people who are obese were $1,429 higher than those of normal weight.

Dr. Galati and the Liver Specialists of Texas team are dedicated to evaluate, treat, and manage all aspects of obesity and non-alcoholic fatty liver disease (NAFLD and NASH), including the complication of cirrhosis and liver failure. Developing a customized plan of care for each patient they see is their objective.

Liver Transplant Resources

Dr. Galati has been involved in Liver Transplantation since 1989. As Medical Director for the Center for Liver Disease and Transplantation at Houston Methodist Hospital, Dr. Galati has cared for thousands of patients with advanced liver disease. In those with the most severe form of advanced liver disease and cirrhosis, liver transplantation is a life-saving surgery. For more information on liver transplantation, click here.

Indications for liver transplant include:

Online LIVER Second Opinion

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    From the comfort of your home, without the need to spend additional money on travel, lodging, and food, receive and expert second opinion from the expert physicians at Liver Specialists of Texas

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    There are five steps in the process of requesting a second opinion. We anticipate the steps will take you about 30-65 minutes to complete.

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    Have your medical records or those of your loved one on hand as you fill out the medical history questionnaire portion of the online process. The medical history questionnaire is detailed so having medical records to quickly reference will help make the process more efficient.

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    To start the process of an Online Liver Second Opinion, please fill out the initial contact form and fax back to our office. A representative from our office will call you for additional details.