Liver Cancer Patient Edward Pachasa
Having survived the loss of his left kidney to a tumor in 1980 when he was 53, in December 2008 Edward Pachasa thought it odd when he felt a pain in his left side.
"There's nothing on my left side.'' As it turned out, an MRI revealed he now had a tumor on his liver, and Pachasa was referred to Perry Shen, MD, the surgical oncology fellowship program director at Wake Forest Baptist Health.
Shen told him he'd have to remove 75 percent of the liver, an organ crucial to digestion, detoxification and synthesizing proteins. Pachasa was 81 at the time.
"I said 'Doctor, I just bought a new set of golf clubs, and I have a 10-year guarantee on them. And I expect a 10-year guarantee on this surgery you're going to do on me because I intend to wear those clubs out.'"
Pachasa says Shen studied him and pondered the request.
"He thought for a minute and then he said 'How about 5?' I said 'I'll take it.'"
Pachasa, 87, smiles as he tells that story, especially the punch line.
He knows he is one of the lucky ones, having survived the loss of his kidney, the 2008 liver surgery and a second liver surgery in 2012, when a new tumor was discovered and again surgically removed by Shen.
"He's like one in several thousand patients,'' Shen says. "He really beat the odds.''
A Difficult Cancer
Liver cancer is not considered a common cancer in the United States. The American Cancer Society projects there will be more than 30,600 new cases of liver cancer in 2013, resulting in more than 21,600 deaths. At Wake Forest Baptist, liver cancer was the 15th most common cancer, with 69 cases recorded in 2011.
Liver cancer is more prevalent overseas because it is most often caused by earlier bouts of hepatitis B or hepatitis C infection, a problem more common in Pacific countries such as Japan and China. Liver cancer also is common among people who have cirrhosis of the liver.
Shen says treating liver cancer is difficult because, unlike Pachasa, most people are not candidates for resection, a surgery in which the tumor is removed. Because symptoms are not easily recognizable, tumors frequently become too large or complicated to remove at the time of diagnosis and patients must undergo other types of treatment.
In transarterial chemoembolization treatment, chemotherapy is delivered through a catheter into the groin artery that supplies the liver tumor. Particle agents added to the chemotherapy drug block the flow to other areas of the body, with the goal to kill the tumor and not damage anything else.
But at best, chemoembolization and other non-surgical treatments buy time for liver cancer patients, because the body becomes resistant to treatment. About 80 percent of liver cancer patients see a recurrence in tumors, one of the highest recurrence rates of any cancer.
Pachasa was that rare liver cancer patient who had none of the traditional causes. He did not have cirrhosis of the liver, nor had he ever had a hepatitis infection.
"Liver cancer tumors can be aggressive,'' Shen says. "Yet it was not a problem for him.''
Pachasa was probably too old to be a candidate for a liver transplant, which in addition to resection, is the best option for liver cancer patients. When it comes to removing a liver tumor, Shen says the key is whether what will be left behind is enough.
"You need at least 20 to 25 percent of the normal liver to have adequate function,'' Shen says.
In Pachasa's case, not only did he have about 25 percent of his liver remaining after the 2008 surgery, but Shen says his liver did something common in such cases-it enlarged over time to function better.
Pachasa is humbled by the fact that he's survived three tumors and has not been forced to undergo chemotherapy or radiation. He is healthy and vibrant-the only sign of illness an upside-down, V-shaped scar that begins above his navel and runs for about 8 inches.
His wife, Ginny, says she views her husband's illnesses "with utter amazement, really. He bounced back so well I just couldn't believe it.''
The Pachasas' adult children got in on the act to help their father. Son Donald came from Ohio after the 2008 surgery to help, and after the most recent surgery, daughters Eileen and Bonnie Jean did most of the caretaking.
Pachasa still makes it to the golf course, and gets down on the floor to play with the Lionel train set that takes up half the living room of the home he and Ginny bought in High Point back in 1980, just before his original kidney tumor was diagnosed. He even spends a couple of hours making pizzelles, an Italian pastry, to bring to Shen before every six-month checkup.
He doesn't worry about another recurrence. In fact, when the latest tumor was spotted in February 2012, he says, "my only reaction was 'Let's get on with it. This is February. I want to play golf this summer.'
"I didn't throw up my hands like other people or go into despair. I just accepted it,'' he says. "I'm 87, you know, what the heck, I've had a wonderful life.''