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Author Topic: Does HCV without cirrhosis cause primary liver cancer?  (Read 649 times)

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Offline dragonslayer

  • Member
  • Posts: 852
Does HCV without cirrhosis cause primary liver cancer?
« on: October 12, 2018, 01:39:28 pm »
Hi All, back again!  So, 6 mos ago, my PCP told me to get a cardiac calcium cat scan which is common for  folks my age.. The results werent bad as far as the heart goes, but it picked up a small nodule in each lung.  The recommendation was to  get the chest rescanned 6-12 mos later.. That I did last tuesday.. Results were that the nodules hadnt grown and were stable, but, under the heading of 'if its not one thing its another', it also picked up something else, which was a portion of the liver that wasnt scanned in the 6mo ago scan.. In the left lobe is a small 'lesion'.. 1cm x 1.7cm.  So I was ordered by my PCP to go for an Ultrasound, which I have scheduled tomorrow.

Im freaking out here.. Ive had 2 liver biopsies, both of which showed no liver damage, stage 0 and 0-1.  That was as recently as 4 years ago just  prior to treatment. I got treated and cured in early 2015.

The radiologist report pertaining to this, dated 10/10/18:

"UPPER ABDOMEN: A lobulated hypodense lesion in the inferior left hepatic lobe
measuring 1.0 x 1.7 cm (series 2 image 63/72); portion of the liver
containing this lesion is not imaged on the previous study."

and

"A 1.0 x 1.7 cm hypodense lesion in the left hepatic lobe has Hounsfield units
somewhat greater than expected for a simple cyst. Consider focused ultrasound
correlation."

I thought that without liver damage/cirrhosis, HCV in its own right was not a causative factor for  HCC.  My drinking since treatment has been minimal, averaging  about 3-5 drink equivalents per week which my hepatologist signed off on at end of treatment saying I can carry on as those I never had HCV.

So, then, why this lesion?  I realize it might only be a cyst, but the way the radiologist words his report has me concerned.

Maybe tomorrow's ultrasound will shed some light on the situation in a good way.. Until then, freaking out....

Paul
« Last Edit: October 12, 2018, 01:50:56 pm by dragonslayer »
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

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  • Member
  • Posts: 3,951
  • Get tested, get treated, get cured, fight Hep c!
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #1 on: October 12, 2018, 08:05:21 pm »
Found a few links including one from hep mag. Apparently while cirrhosis is a higher risk of liver cancer Hep C alone is also a liver cancer risk.

https://www.hepmag.com/basics/hepatitis-c-basics/liver-cancer

Wow this sounds very concerning hoping you have better news soon. Have you had an AFP blood test? AFP although an imperfect diagnostic tool if significantly elevated can give an indication of possible liver cancer.

Please let us know what you find out.

Sending positive energy your way
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 lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #2 on: October 12, 2018, 09:45:04 pm »
Benign lesions are very common. Some people just make benign growths and the fact that you already have the 2 in the lungs suggests that you may have something benign elsewhere.
That said, who isn't going to be freaked out until this is confirmed? So, we'll freak out with you, albeit in a more supportive way.
Although this is likely to be nothing, if it is serious, its been caught very early, when treatment has a high cure rate.
Let us know.

Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
http://blogs.hepmag.com/lucindakporter/

Offline dragonslayer

  • Member
  • Posts: 852
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #3 on: October 12, 2018, 09:51:34 pm »
Thanks you guys; you're the best!  Ill get back with any new info.
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

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  • Member
  • Posts: 3,951
  • Get tested, get treated, get cured, fight Hep c!
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #4 on: October 13, 2018, 01:44:43 am »
Thanks Lucinda! I’m so glad to hear there is a good chance of this being benign.
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 dogdave

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  • Posts: 51
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #5 on: October 15, 2018, 10:28:21 am »
Hey Dragonslayer,  it is my understanding that they won't do a biopsy on the tumor itself.  The reason is that opening a cancerous lesion could leak cancer cells out to spread.  Also, non-cirrhosis is less of a breeding ground for tumors than one with cirrhosis.

They could take a wait and see approach or they might do some kind of embolization treatment. Both are highly successful.  I know it is stressful, but the professionals will walk you thru this.

Last year at this time I was diagnosed with a 4.5 cm tumor.  I had a chemo-embolization successfully treat it. However because of the state of my liver with cirrhosis, I am now listed on the Transplant list. 

Good luck to you with this!  David
contracted 1970's dx 1996
non responder to various interferon regimes late 90's
4 Liver Biopsies F2
Fibrosure 12/12/14 stage 4 liver cirrhosis
GT 1a VL 2.7 million beginning treatment
Start tx 3/27/15
4 weeks Labs: 4/23 VL 61
8 weeks Labs: 5/22 VL UNDETECTED!
Finished on 9/11/15, 24 wks of Harvoni

Offline dragonslayer

  • Member
  • Posts: 852
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #6 on: October 16, 2018, 09:35:31 am »
Update:

Got results of the followup Ultrasound.  It's a Complex Cyst and not the Simple Cyst I was hoping for.  So, MRI with and without contrast has been ordered.  That will be the third imaging for this I will have had.. I asked my doctor point blank, 'Doc, do you think its cancer?'.   She replied  'no', but I have my doubts.  Further tests will hopefully clear this up.    I dont think I have symptoms, and liver function tests have been normal.

Although I suppose it's conceivable this cyst arose spontaneously, nothing regarding HCV has been simple for me. As you recall, I was one of the very few who was still detected at EOT and at 8 wks post, not  becoming Undetected until the 12 wk post test.  I have no idea how old this cyst is, and,  this being the first imaging, have no way to determine its growth rate... On the positive side, liver looks otherwise healthy on the ultrasound, and there's no cirrhosis, or abnormalities on other organs.  BTW, radiologists seem to use the most obtuse language sometimes: 'if clinically indicated'.. Hard to find a definition for this phrase that means anything.

"LIVER: There is a complex, septated cyst within the left hepatic lobe
measuring 1.7 x 1.4 x 2.4 cm. There is no associated vascularity. This is
similar when compared to the prior chest CT. Dedicated three-phase hepatic CT
or MR could be considered to help further evaluate if clinically indicated.
The liver demonstrates normal size, contour and echogenicity. No intrahepatic
biliary duct dilatation
."
« Last Edit: October 16, 2018, 02:17:55 pm by dragonslayer »
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 3,951
  • Get tested, get treated, get cured, fight Hep c!
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #7 on: October 16, 2018, 12:20:19 pm »
My best guess for ‘if clinically indicated' is if the doctor thinks it is a good idea.

Waiting along with you for good news
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 dragonslayer

  • Member
  • Posts: 852
Re: Does HCV without cirrhosis cause primary liver cancer?
« Reply #8 on: October 16, 2018, 04:19:39 pm »
Ive been trying to find statistics regarding DAA cured HCV patients who went on to develop de novo primary HCC after treatment, and what percentage of them had been diagnosed with cirrhosis.

I came across this interesting (but long!) recent study that published results with a cohort of 819 patients. It also compared HCC rates among those treated with IFN vs DAAs.

Regarding the incidence among those without cirrhosis, it found:

"Results: A total of 819 patients were included in the DAA group. The median follow-up period was 263 days (0–1,001). Twenty-five patients (3.6 HCCs/100 person-years; 3.1%) were diagnosed with de novo HCC within the time of observation. No patient without cirrhosis had developed HCC."

And, countering the concerns that had abounded for some time regarding whether or not DAAs caused HCC, and subsequently debunked, the finding was this:

" Conclusion: The de novo HCC rates did not differ between the DAA-treated patients and those who received IFN. Achievement of SVR is of utmost importance for HCC prevention."

So, it seems to be that the incidence of HCC in non cirrhotic  individuals who have achieved SVR to be extremely low, even though HCV in and of itself is listed as a risk factor.

Interesting study:

https://www.karger.com/Article/FullText/486812


I had to get a blood test today for kidney function, required before radiology will do the MRI with contrast.  Waiting for them to schedule the appt.   In the meantime, every hint of any 'could-be' symptoms of HCC that Im feeling freak me out just a little bit more, naturally.  I really dont understand how with my pristine liver, never having had any measurable liver damage, it could succumb to this.   

« Last Edit: October 16, 2018, 08:56:42 pm by dragonslayer »
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

 


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