What to do About Liver Tumors

This is a very complicated question since EHE patients often have liver tumors that don't substantially affect life quality unless they cause pain which can be anywhere on a spectrum from nothing to severe. So, what to do about those buggers? What I can say off the top of my head is that for (the rare) patients with a solitary operable lesion, resection is best. However, as you know, most people with liver involvement (ie HEHE) have extensive disease (both lobes, multiple tumors); then, I believe most people think surgical excision is not advisable. Patients in this situation often decide to do nothing; especially since liver function (assessed by lab tests called 'LFTs' are often normal. Moroever, there's no evidence I'm aware of indicating that treating these exerts a survival benefit - maybe it does, we just don't know. In any case, many people decide it's best to kill the tumors and have used any of a variety of IR (interventional radiology) procedures. They involve different ways of killing tumor at the end of a catheter that is passed into the tumor under fluoroscopy either directly or via arteries that feed the tumor; these include: radiofrequency ablation = heat; electroporation = osmotic shock; yttrium 90 microsphere = radiation; chemo- or bland-embolization = cutting off blood supply. Finally, there's complete removal, ie liver transplant. the pro- con- of this decision is very complex and will be addressed in another post. Here, you're balancing lots of risks and benefits, for instance, all the risks of transplant (surgery, immunosuppression, etc) against a theoretical benefit and the unknown risk of leaving the tumors in place. One of the most important things to consider is that transplant is a one-way trip. Chemo, trematinib, RT, all those, you can start and stop. but transplant is different: it takes you to a new world and new way of life from which there is no return. For many people with symptomatic HEHE, this is good, cause they don't want to go back to where they were. The other good news is that there is a lot of experience with LTx in EHE (UNOS and European groups); moreover, LTx impacts quality of life a lot less than I expected or predicted it would. If you compare the survival (Meier - Kaplan) plots for LTx in EHE versus those without EHE, they look very similar. That is, the EHE seems to exert no influence on survival after transplant, suggesting that in a way you've reduced the disease burden or diminished somewhat the effect of EHE on survival...at least that's the way I view it. So, it's complicated and provides good food for thought. I think many people would be surprised to know that LTx, after a period of recovery, affects your life a lot less than you'd think....at least that's our experience.