Patient Stories

Hepatitis C and Liver Cancer: A Silent Threat for Baby Boomers and Beyond

Oct. 26, 2021

Fred Coates, MD, was running out of time and options after being denied a liver transplant. A second chance came by way of a transplant at UC Health.

Fred Coates, MD, enjoys spending his time working on his 26-acre farm in central Kentucky alongside Debbie, his wife of 40 years. Every minute mending fences and mowing grass is a precious gift for the 75-year-old anesthesiologist.

It is time that was nearly cut short by an aggressive primary liver cancer, one of the leading causes of cancer deaths worldwide. “I’m continuing with my regular life now that I don’t think it’s coming to an end anytime soon,” Dr. Coates said.

A liver transplant was Dr. Coates’ only chance for survival. He was denied at his local hospital because of his age. He did not even get an evaluation with the transplant team.

“I don’t think I had much longer to live based on the pathology report,” Dr. Coates said. “I had sort of given up and just thought I was going to die from my liver cancer.”

But then, “I got a reprieve,” he said. About 100 miles north of his home, Dr. Coates would find hope with the expert transplant team at UC Health.

His nephew, a student at the University of Cincinnati College of Medicine, had studied with Shimul A. Shah, MD, UC Health transplant surgeon and the James and Catherine Orr Endowed Chair of Liver Transplantation; director of the Division of Transplantation and professor in the Department of Surgery at UC College of Medicine.

The connection would ultimately lead to the transplant he so desperately needed.

Hepatitis C: A Major Risk for Liver Cancer

The journey to transplantation for Dr. Coates began in the 1990s when a blood test revealed he was positive for the hepatitis C virus. At the time, treatment options were very limited.

Many people with hepatitis C may not even know they carry the virus because symptoms can be mild and look like other health problems. A chronic infection can slowly and silently lead to long-term liver damage and a higher risk for developing liver cancer.

Hepatitis C infections have been so common among baby boomers, like Dr. Coates, that in 2012, the Centers for Disease Control and Prevention recommended that everyone born between 1945 and 1965 get tested to prevent hepatitis-related diseases, including cirrhosis and liver cancer.

Today, hepatitis C is curable. In fact, with the help of prescription medication, Dr. Coates was eventually cleared of the disease in 2017. But by that point, the chronic infection had already done serious damage to his liver.

Risk Becomes Reality for Dr. Coates

The first warning signs of trouble ahead for Dr. Coates came in 2005, when a liver biopsy detected stage 5 fibrosis – advanced scarring caused by hepatitis C that eventually developed into cirrhosis.

“Screening of all patients with cirrhosis is critical due to the high risk of developing hepatocellular carcinoma (HCC) which we estimate is roughly as high as 6% per year,” Dr. Shah explained.

Various treatments for his hepatitis C infection were attempted to bring the virus under control. Some did not produce enough of a response to continue, while others like an experimental three-drug regimen attempted around 2012, took a toll on his body.

“I had a good biological response, but I started shedding skin and had to get blood transfusions twice,” Dr. Coates said. When the prescription medication finally rid him of the disease in 2017, he was still monitored because of his elevated liver cancer risk tied to the hepatitis C virus and cirrhosis.

In January 2019, that risk turned into reality.

An abnormal growth was detected on an ultrasound. Another was detected by an MRI. A third was found during surgery to remove them.

A year would go by, and more abnormal growths and lesions appeared.

“I talked about a transplant, but they said that was not going to happen,” Dr. Coates said.

Instead of a transplant, Dr. Coates’ treatment team opted for transarterial chemoembolization, or TACE, to treat the liver cancer that returned despite the surgery. Chemotherapy beads were placed into the liver to attach the tumors.

The tumors kept growing. Radiation therapy was added to the treatment plan. It wasn’t working.

Fortunes changed when Dr. Coates’ nephew relayed the story to Dr. Shah.

“I owe them my life.”

Dr. Coates fondly remembers the first time he talked to Dr. Shah. It was a phone call on a Saturday.

“What a fine person he is! He is just a wonderful person,” Dr. Coates said. “He had me come up for an evaluation. By the time I was up there, I had lesions all through my liver.”

Dr. Coates continued, “Dr. Shah said he would have transplanted me after my first surgery. I had hoped that I was not going to be a cancer patient anymore – but I was going to be a liver transplant patient.”

The first step was to finally bring the liver cancer to a halt. The UC Health team determined that the radiation treatment he received in Kentucky wasn’t strong enough.

“When Dr. Coates came to us, his CT scan showed dozens of liver cancer lesions throughout his liver. In Kentucky, he had received multiple interventional treatments to his liver, which were directed at only a some of the cancers and used radiation doses that were too low,” explained Ross Ristagno, MD, UC Health interventional radiologist and associate professor in the Department of Radiology at the UC College of Medicine.

Dr. Coates needed more aggressive interventional radiology treatments urgently to control the aggressive cancer and qualify him for liver transplantation. Dr. Ristagno explained, “Dr. Coates underwent radioembolization procedures to both lobes of his liver. Both treatments were performed at UC Health as outpatient procedures and were well tolerated by him.”

UC Health Interventional Radiology physicians have specialized in performing minimally invasive liver cancer therapies for many years. Their team of nine interventional radiologists have trained in the best medical centers in the country and bring their expertise to UC Health. The team was the first in Ohio to perform liver cancer radioembolization in adults and the first in the country to perform this procedure in children.

According to Dr. Ristagno, close collaboration between interventional radiology physicians and their UC Health Transplant colleagues “allows us to achieve amazing results, such as in Dr. Coates’ case and with other patients.”

“After four weeks, it showed all of my lesions were necrotic (dead).” Dr. Coates said. “I had this little window to get transplanted.”

An additional scan for cancer showed his cancer had not spread beyond the liver.

After years of being told he was too old, he was finally on the transplant list at UC Health.

The wait wasn’t long. The same day he was placed on the list, the phone rang when he got home.

“I got a call that night to come back to Cincinnati,” Dr. Coates said.

Fred and his family did not hesitate. His daughter, Jennifer, a registered nurse, immediately booked a flight from her home on the west coast to see her dad through the operation.

Outlook for the Future

Dr. Coates’ transplant was a success, and he is now cancer-free. “Every person who took care of me at UC Health was excellent,” he said. “Within a week, I felt like I did before I was in surgery.”

Today, Dr. Coates is back on his farm as active as ever. “I just put new framing in my window and took my tractor apart. I’m about to put new flooring in.”

He credits Debbie and Jennifer, along with his 8-year-old granddaughter Lily, for giving him the support he needed during his recovery.

He has also become an incredible advocate for the transplant program at UC Health, sending more patients their way for successful transplants like his.

“We have long recognized that transplant is the superior cancer operation in patients with hepatocellular carcinoma (HCC), especially those who are unresectable,” said Dr. Shah. “But in Dr. Coates’ case, his tumor was advanced. Here at UC Health, we have an experienced multidisciplinary approach for patients who wouldn’t have been considered at most other centers.”

“Don’t make assumptions about what can and cannot be done. Make an appointment and talk to the people there,” Dr. Coates said.

Get Tested, Ask for Second Opinion

Newer data on chronic hepatitis C has found the virus to be more common across generations than previously thought. Today, the CDC recommends that everyone over the age of 18 gets screened for the hepatitis C virus.

Now that hepatitis C is curable, early screening is key to reducing the risk for cirrhosis and liver cancer, like Dr. Coates experienced before effective treatments were more widely available.

UC Health is committed to advancing medical options and expanding transplant eligibility for patients with liver disease and liver cancer. For more information or to schedule an appointment, call 513-584-9999.