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Author Topic: liver cancer after heo c treatment  (Read 14075 times)

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Offline anniemybaby

  • Member
  • Posts: 133
liver cancer after heo c treatment
« on: April 09, 2015, 05:49:24 pm »
My family Dr told me today that even though I'm undetected after harvoni treatment my chances of liver cancer are still high because I had hep c is this true? Do I need to continue to worry about my liver after treatment? Im not completely out of woods yet I was undetected at 4 n 8 wks but need to do a 3 n 6 month test
Annie

Offline motor

  • Member
  • Posts: 58
Re: liver cancer after heo c treatment
« Reply #1 on: April 09, 2015, 09:01:30 pm »
My dr told me same, having had hepC puts us at higher risk of liver cancer.  He plans to schedule liver ultrasounds to monitor.
Age 66male GT 1a/CT  Dx 5/19/14
Likely infected early 70's
VL 3.7mil FibroScan F2 FSure F2
ALT 84(12-78) AST 56(3-36) High
Tx naive
8wks Harvoni start 3/3/15 VA
4wks ALT 25(12-78) AST 22(3-36) Normal 
        VL  <15  NOT DETECTED
8wks ALT 24 AST 19 
EOT  VL   <15  NOT DETECTED
SVR12 VL <15  NOT DETECTED

Offline sapphire101

  • Member
  • Posts: 238
  • "Stop worrying and start living"
Re: liver cancer after heo c treatment
« Reply #2 on: April 10, 2015, 12:58:22 am »
OK this is disturbing news.
Moderators any information would be appreciated.
Sapphire101
Genotype 1a Fibrosis level 1
Viekira Pak with ribavirin 12 weeks
Pre treatment  VL  1.7 million, AST 45 ALT 65
EOT VL not detected, AST 21 ALT 21
12 week SVR not detected,24 week SVR not detected.
Cured! Class of 2015

Offline Lynn K

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  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: liver cancer after heo c treatment
« Reply #3 on: April 10, 2015, 04:00:09 am »
My understand is the elevated liver cancer risk is for those with cirrhosis. But even for those like myself our risk of liver cancer is greatly reduced. As for those with minimal liver damage say F2 or less I have read the recommendation is those patients can be treated as though they never had hep c.

But yes for those with cirrhosis we will still need our regular blood work (mine is every 6 months) to include AFP and abdominal ultrasound to monitor for liver cancer

OK found the reference it is from our friends at the AASLD in the treatment guidelines

http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

excerpt from the Box Summary

Recommended follow-up for patients who achieve a sustained virologic response (SVR).

For patients who do not have advanced fibrosis (ie, those with Metavir stage F0-F2), recommended follow-up is the same as if they were never infected with HCV.

Rating: Class I, Level B

Assessment for HCV recurrence or reinfection is recommended only if the patient has ongoing risk for HCV infection or otherwise unexplained hepatic dysfunction develops. In such cases, a quantitative HCV RNA assay rather than an anti-HCV serology test is recommended to test for HCV recurrence or reinfection.

Rating: Class I, Level A

Surveillance for hepatocellular carcinoma with twice-yearly ultrasound testing is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR.

Rating: Class I, Level C

A baseline endoscopy is recommended to screen for varices if cirrhosis is present. Patients in whom varices are found should be treated and followed up as indicated.

Rating: Class I, Level C

Assessment of other causes of liver disease is recommended for patients who develop persistently abnormal liver tests after achieving an SVR.

Rating: Class I, Level C

full text

With the advent of highly effective HCV antiviral regimens, the likelihood of achieving an SVR among adherent, immunologically competent, treatment-naive patients with compensated liver disease generally exceeds 90%. Of patients who achieved an SVR with PEG-IFN  and RBV treatment, more than 99% have remained free of HCV infection when followed up for 5 years after completing treatment. (Manns, 2013) Thus, achieving an SVR is considered a virologic cure of HCV infection.

SVR typically aborts progression of liver injury with regression of liver fibrosis in most but not all treated patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Because of lack of progression, patients without advanced liver fibrosis (ie, Metavir stage F0-F2) who achieve an SVR should receive standard medical care that is recommended for patients who were never infected with HCV.

Among patients with advanced liver fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR, decompensated liver disease (with the exception of hepatocellular carcinoma) rarely develops during follow-up, and overall survival is prolonged. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients who have advanced fibrosis or cirrhosis continue to be at risk for development of hepatocellular carcinoma after achieving an SVR, although the risk in these patients is lower than the risk in persistently viremic patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis who achieve SVR experience increased survival (compared with patients with cirrhosis who are untreated or in whom treatment fails), but still may be at some risk for hepatocellular carcinoma; thus, they should continue to undergo regular surveillance for hepatocellular carcinoma despite the lowered risk that results after viral eradication. (Bruix, 2011) The risk of hepatocellular carcinoma among patients with advanced fibrosis prior to treatment but who have regression to minimal fibrosis after treatment is not known. In the absence of data to the contrary, such patients remain at some risk for hepatocellular carcinoma and should be monitored at regular intervals for hepatocellular carcinoma.

Liver fibrosis and liver function test results improve in most patients who achieve an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Bleeding from esophageal varices is rare after an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis should receive routine surveillance endoscopy for detection of esophageal varices if not previously done and these should be treated or followed up as indicated. (Garcia-Tsao, 2007)

Patients in whom an SVR is achieved but who have another potential cause of liver disease (eg, excessive alcohol use, metabolic syndrome with or without proven fatty liver disease, or iron overload) remain at risk for progression of fibrosis. It is recommended that such patients be educated about the risk of liver disease and monitored for liver disease progression with periodic physical examinations, blood tests, and potentially, tests of liver fibrosis by a liver disease specialist.

Periodically testing patients with ongoing risk for HCV infection (eg, illicit drug use, high-risk sexual exposure) for HCV reinfection is recommended. Flares in liver enzyme test results should prompt evaluation of possible de novo reinfection with HCV through a new exposure (see Management of Acute HCV Infection). Antibody to HCV (anti-HCV) remains positive in most patients following an SVR. Thus, testing for reinfection with HCV is recommended and should be performed with an assay that detects HCV RNA (eg, a quantitative HCV RNA test).


Hope that clears it up for you
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Mike

  • Member
  • Posts: 999
Re: liver cancer after heo c treatment
« Reply #4 on: April 10, 2015, 12:20:10 pm »
Thanks, Lynn,

Great post!

Mike
Genotype 1a
Treated 2001 with PEG and RIBV
Treated in 2014 SOL+PEG+RIBV
Cured July 2014

Offline sapphire101

  • Member
  • Posts: 238
  • "Stop worrying and start living"
Re: liver cancer after heo c treatment
« Reply #5 on: April 10, 2015, 10:15:48 pm »
Wow Lynn K. You continue to amaze me with your knowledge. I will print this reference to give to my primary physician on that happy day in the future when I graduate to post treatment.
You work as a machinist right? You should think about a career change to liver health counselor or coach.
Sapphire101
Genotype 1a Fibrosis level 1
Viekira Pak with ribavirin 12 weeks
Pre treatment  VL  1.7 million, AST 45 ALT 65
EOT VL not detected, AST 21 ALT 21
12 week SVR not detected,24 week SVR not detected.
Cured! Class of 2015

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: liver cancer after heo c treatment
« Reply #6 on: April 10, 2015, 10:31:26 pm »
Well thanks but I just read too much.

I would really wish I was still blissfully ignorant of all this ya know and just living life

But I guess we sometimes have forks get stuck in our roads :)
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

 


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