"There's a myth that anyone who has a liver problem has brought it on themselves" This quote is from a Crohn's disease patient living with a blocked portal vein hoping for a liver transplant (Independent 31st Oct 2010)

Monday, 15 November 2010


Collected the print-out of my November 4th tests from the GP. The blood chemistry ones confirmed what had been read to me over the phone. Normal apart from one or two little blips - sodium low by 1 mmol per litre, teeny tiny amount. ALT 59 (upper normal is 35) which indicates damage by inflammation, i.e. hepatitis. ALT will always be high. Then on to the histopathology; the examination of the tissue taken at biopsy.
Tumour weight 10 grammes. How much is 10g? 2 Brazil nuts + 4 almonds! Not much help for visualization if you don't have nuts (!) so I eat them and weigh a £1 coin. Bang on 10g.
Tumour diameter: 16mm - same as a 5p.
Tumour cells present at margin: 0
Capsule: intact
Specimen size (including a decent margin) 34x33x21mm. That looks quite big when I draw it as a cube. I wonder if it's re-grown.
Tumour stage: T2; not so good, I thought it was a T1. T2 means involvement of surrounding blood vessels. It conflicts with the statement "no vascular involvement" further down the list.
Tumour grade (this is how aggressive it is): The Grades are 1 to 4, 1 being the least aggressive. Mine was G2/3.
Background liver; Fibrosis, established cirrhosis, hepatitis B. Then something I've yet to find a layman's definition for "persistent florid activity'. The closest I can find is that it might mean there is still evidence of hepatitis inflammation/activity.
So why am I interested in something that isn't there any more? Because the report gives an educated guide to recurrence. In academic papers this is divided into early recurrence (less than 1 year) or late (slower than 1 year). Significant risk factors for early recurrence in small HCC are:

(1) serum alpha-fetoprotein (AFP) level >100 ng/ml; mine was 152 at the time of the histology report. (2) lack of tumor capsule formation; mine was intact. (3) microscopic vascular invasion; mine was described as absent. (4) high Edmonson-Steiner grades; on a scale of 1-4 mine was G2/3.

No comments:

Post a Comment