When UAMS oncologists found malignant tumors on Carroll Martindale’s liver in 2010, he believed he had four months to live. An “exercise nut” with no family history of cancer, he was shocked to hear that he needed a liver transplant.
“If it wasn’t for Dr. Borja-Cacho and Dr. Beheshti, I would have been dead,” said Martindale, 73. “UAMS doctors are the best. They explained everything to me and I knew what was going on. I had very little problems with my treatments.”
Four months after Martindale’s liver transplant in March 2013, performed by UAMS’ multidisciplinary liver transplant team, he was biking, walking and hitting the golf course.
“I would recommend the UAMS Cancer Institute to anybody in the world. They really took care of me.”
About 70 percent of the patients with hepatocellular carcinoma, the most common type of liver cancer, can live up to five years after surgery, said Daniel Borja-Cacho, M.D., assistant professor in the UAMS College of Medicine’s Department of Surgery. Martindale is one of the few liver cancer patients each year who are able to receive a transplant.
“In the U.S. about 16,000 people are waiting for a liver and we only perform about 6,000 liver transplants a year,” Borja-Cacho said. “This means that we do not have a liver for everybody.”
Because a liver transplant is not an option for every patient, UAMS offers alternatives that have proven successful. These include chemotherapy, local intravenous radiation to shrink the tumors, or surgery to remove the cancerous portion.
“Liver cancer treatment requires a multidisciplinary team, and we have a great one,” Borja-Cacho said. “We have hepatologists, interventional radiologists, medical oncologists and liver surgeons, who all work together to review every single patient’s case. With this type of team treatment we can provide the best possible outcome for the patient.”
The type of treatment is based on the stage of the cancer and the patient’s overall health, including whether there are disorders such as diabetes, heart problems, cirrhosis or viral hepatitis — the most influential risk factor for liver cancer.
However, viral hepatitis as a cause of liver cancer could take a backseat to obesity in the next 10 years, Borja-Cacho said. Obesity is increasing at alarming rates in Arkansas and the nation. One-third of Arkansans are obese, and obese people have more fat in the liver. Severe cases of fatty liver – when fat makes up more than 5-10 percent of the weight of the liver – can lead to cirrhosis and eventually liver cancer.
Metastatic liver tumors, meaning cancerous tumors that originated in the liver but have spread to other areas of the body from the liver, also affect the choice of treatment.
“Our oncologists and hepatologists have options for patients with metastatic disease,” Borja-Cacho said. “The difference is that those with a metastasis cannot benefit from a liver transplant because the cancer has spread. However, a transplant can cure a patient with cirrhosis.”
UAMS oncologists are even capable of shrinking liver tumors for a patient to be a transplant candidate.