4-23-19 -The Diagnosis

Primary Clear Cell Variant Hepatocelluar Carcinioma.  Stage lV

This carcinoma is very rare and usually seen in Renal(kidney) cancer.  The tumor mass is on his liver about 20x17cm in size with a tumor thrombus extending from liver to Right atrium of his heart. There are also multiple lung metastatic disease in both lungs.  Most cancers have guidelines ie. If cancer is this type do this, If tumor is this size do this, if metastatic do this etc.  These are called NCCN guidelines and are followed by all that treat cancer whether you are at a big well known institutions like Sloan-Kettering, MD Anderson or a smaller institution like Upstate Medical Center and Cancer Center that James is presently being followed. For his cancer because it is so rare there are no guidelines.  His doctor has contacted Doctors at Sloan Kettering, Dana Farber in Boston and Roswell Park among others.  He plans to contact MD Anderson as James has family there but is not holding out much hope of finding any Doctors that can say what to do for this cancer.  Since Liver Cancer in general does not respond well to chemotherapy, he is going to treat as he would a renal clear cell carcinoma with immunotherapy.  The drugs he will be using are Nivolumab and Ipilimumab.  Both are monoclonal Antibodies which basically stimulate the immune system to fight the cancer.  They do not have the typical side effects  as chemotherapy, such as hair loss , Nausea, Vomiting, etc. however they can have some severe side effects such as Pneumonitis, Colitis, etc. that can occur.  We really have no choice.  The cancer is growing at an alarming rate and James doctor stated that James has 3 months or less if no treatment.  The most pressing issue is that the tumor is growing inside his Inferior Vena Cava, a vessel from the liver to the heart.  This vessel is 90% occluded.  They now plan to stent this much like they would in a heart procedure called a Cardiac cath.  This would hopefully prevent an occlusion of the IVC.  James as always remains optimistic and faithful.

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