At 66, Donald Fuhrman, a retired real estate broker and investor, looked like many men his age: enjoying world travel and in good health with just slightly high cholesterol. Appearances can be deceiving.
During his annual physical exam, Fuhrman's blood tests revealed elevated liver enzymes that concerned his family doctor. What started as a routine visit led to an ultrasound, CT scan and MRI, all inconclusive.
It was a liver biopsy that showed that Fuhrman had intrahepatic cholangiocarcinoma or cancer of the bile ducts, a rare form of cancer that rapidly progresses to lethal stages. Fortunately, the cancer appeared to be localized to the liver so the next step was surgery.
Through an advanced minimally-invasive procedure called laparoscopy, Andrew M. Lowy, M.D., chief of surgical oncology at Moores UCSD Cancer Center, completely removed the cancerous tumor without the need for a large 8-12 inch incision.
Instead, three small incisions were made in the abdomen to remove the cancer: one half-inch incision for a camera, a second half-inch incision to pass surgical instruments, and a third 3-inch incision to remove the diseased area of the liver. None of the major muscles of the abdominal wall were cut or sacrificed and no blood transfusions were required. Furhman returned home in three days as opposed to a 7-10 day hospital stay.
"Because of the significant flow of blood to the liver, surgery on this organ is one of the most complex and delicate gastrointestinal procedures," said Lowy.
"Minimally invasive techniques can now be performed with limited blood loss thus helping the patient return home quickly. In Mr. Fuhrman's case, all of the cancerous growth was removed, so there was no need for chemotherapy."
"I met Dr. Lowy on a Monday and the cancer was removed on a Friday," said Fuhrman. "I'm a lucky guy. Undetected, a patient with this kind of liver cancer would normally only live two years. I'm cancer free and headed to Utah, Chicago, Panama Canal, and Hawaii."
While some liver diseases are symptomless yet life-threatening, other liver conditions cause great pain but have no impact on life expectancy.
"Before surgery, I had chronic abdominal pain that bothered me night and day," said Kristine Preston, 47, of Valley Center. "I couldn't sleep. I couldn't even walk up my driveway without stopping to catch my breath. I constantly felt bloated and uncomfortable."
Preston's pain became severe and eventually landed her in the emergency room.
"An MRI scan showed cysts on my liver. I was referred to UC San Diego where I met
Dr. Lowy. He reassured me that I didn't have cancer and that a minimally invasive surgery could eliminate the pain," said Preston, a biologist at UC Riverside. "He was right."
Cysts are thin-walled structures that contain fluid often causing sensations of fullness and discomfort. Lowy removed the growths from Preston's liver during a laparoscopic procedure using three small incisions, less than 0.5 inch each. Lowy eliminated the cysts by widely opening the cyst wall and destroying the bottom of the cyst with heat.
"I left the hospital the day after surgery and I am now pain free," said Preston. "It's amazing. I never realized just how much my quality of life had been compromised. I am back to hiking and feeling like myself again."