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Thursday, July 31, 2014
Can Active Cancer Patients Be Organ Transplant Recipients?
5 years ago my mother was diagnosed with a choroidal melanoma. She had a successful enucleation. She has recently been diagnosed with stage 4 melanoma in the liver. Is she eligible for a live donor transplant with a stage 4 melanoma? Would CT be useful and diagnosing further metastasis since melanoma is so undetectable through lab work? Her ca and cea are within normal limits according to her docs, but they say she is in stage 4. My heart is breaking!! My mom is dying right before my eyes.
Sorry to hear this about your mom.
I can only answer the first part of your question about transplant.
We do not transplant for metastatic diseases, be that metastatic colon cancer, breast cancer, etc. The reason being is that there is an enormously high recurrence rate of the "old" cancer coming back into the "new" liver. With few exceptions, most of us would consider such a situation as your mom, as well as others with metastatic disease, to be a SYSTEMIC disease, that is, there would be disease in the lymph nodes, and in other places in which we cannot find. To then give someone a transplant, and to dull their immune system with the drugs needed to allow the organ to "take", would then set up a situation in which the cancer cells outside of the liver (which we cannot see) to grow without check. Because most people with such metastatic disease will likely have disease (tumor cells) outside of their liver, and because we change the immune system enormously with the drugs we use to prevent rejection, we do not allow transplants for patients with metastatic diseases. The cancer would come back into the new liver and the patient would succumb to a much worse and aggressive cancer.
With a metastatic melanoma, I would expect the CA and CEA to be normal. Those markers are very non-specific. What is most telling are her symptoms.
Unfortunately, having a distant lesion from a primary melanoma is a very bad thing. The survival rate is very low and at this time, no treatment for metastatic melanoma has really proven to enhance long-term survival. Perhaps there is some experimental protocol which your mother's doctors can place your mother into.
Best of luck.
Steven M Rudich, MD, PhD, FACS
Professor of Surgery, Director of Liver Transplat and Hepatobiliary Surgery
College of Medicine
University of Cincinnati