By Sean Gorman

The tattoo on Heather Gradine’s finger features a green ribbon, a universal symbol of liver cancer awareness. And the letter “C” next to it? Cure.

It’s a permanent reminder of the 52-year-old's fight against an illness that created a baseball-sized tumor in the middle of her liver before she underwent an extremely rare and complicated procedure at VCU Health Hume-Lee Transplant Center to remove the mass.

The tattoo was inked on her right hand’s middle finger as a statement of defiance against the cancer one of her doctors says would have probably ended her life within a year had it not been removed.

“Everybody says ‘Oh, I wish I could win the Powerball,’” Heather said. “I already won it. I did. I won it by having access to VCU Health.”

Patient Heather Gradine has a tattoo of a green ribbon on her finger, symbolizing liver cancer awareness. The letter “C” next to it stands for “Cure” (Contributed photo).

One day in late 2022, Heather felt a burning sensation while going to the bathroom. She figured she might have a urinary tract infection and went to an urgent care clinic in Chesapeake, where she lives.

Her urgent care doctor suspected appendicitis and sent her to a local emergency room. Appendicitis was ruled out, and testing didn’t indicate a bladder infection or a kidney stone. Doctors told Heather she needed an MRI.

“I was thinking, ‘OK, something’s going on here’ because you don’t just do that,” Heather recalled.

The scan showed a mass within her liver that turned out to be an advanced stage of hepatocellular carcinoma (HCC), a liver cancer that’s a leading cause of cancer deaths around the globe.

The diagnosis came out of the blue. To this day, doctors aren’t sure what exactly led to Heather’s cancer, noting she doesn’t have cirrhosis or an underlying liver condition other than a mild fatty liver.

Seeking a cure at Hume-Lee Transplant Center

Knowing the severity of her case, a liver specialist recommended she go see Vinay Kumaran, M.D., transplant surgeon and surgical director of living liver donor transplant at Hume-Lee Transplant Center.

“He told me, ‘I want you to go see Dr. Kumaran. He’s the best,’” Heather recalled the specialist saying.

With Kumaran, Heather found a reassuring provider who clearly explained her condition and treatment options.

“I really felt like he was in my corner, that he was going to do whatever it took to save me,” Heather said, her voice wavering with emotion. “He was very realistic, but he was also very comforting at the same time.”

At roughly 8 centimeters across, Heather’s tumor was large, but its location within the organ was also concerning. It was right in the center of the liver in an area with major blood vessels that carry most of the body’s blood, greatly complicating any efforts to remove it. The mass had also infiltrated a major vein carrying blood from the lower abdomen up to the heart.

Hume-Lee Transplant Center is equipped to handle complicated cases like Heather’s with a Multi-Disciplinary Liver Cancer Clinic and Tumor Board that draw on the expertise of a range of providers, including transplant hepatologists, radiologists, oncologists, and others who can offer outside-the-box solutions to difficult medical challenges.

Short of getting rid of the tumor, any other treatment would have focused on providing comfort rather than a cure, Kumaran recalls.

“In most other tumor boards, it would just be labeled as an incurable cancer, and they would then go about planning how to slow it down and what palliative treatments can be offered,” he said. “Her options were either palliative, or we try something innovative.”

Extremely rare transplant procedure offers hope for liver cancer patient

Heather’s care team recommended an uncommon procedure to treat her liver cancer. Hume-Lee surgeons would take her liver out of her body, remove the cancerous tumor and then transplant the remaining part of the organ back into her body.

“It was our only chance of actually beating this tumor,” Kumaran said.

Exact figures on how many times the procedure has been performed aren’t available, but Kumaran estimates that it might be done a couple times a year in the United States.

Many medical centers simply lack the range of expertise needed to pull it off, he adds.

Everybody says ‘Oh, I wish I could win the Powerball.’ I already won it. I did. I won it by having access to VCU Health.

Heather Gradine, VCU Health patient and liver cancer survivor

Scott Matherly, M.D., a transplant hepatologist who runs the Tumor Board at Hume-Lee Transplant Center, says removing the liver from the body brings added complications and risks. Rather than a traditional tumor removal surgery, Heather was essentially becoming her own living organ donor. But the other option was leaving Heather with a fatal cancer, Matherly adds.

"Our tumor board is such an important resource because of cases like this,” Matherly said. “The benefit of working with a multidisciplinary team is we can bring our collective expertise to the table and provide innovative and unique solutions to difficult problems."

Heather underwent chemotherapy and radiation treatments to shrink the tumor before the operation. Meanwhile, she worried about staying alive long enough, so she could be there for important family moments like her son’s Ring Figure ceremony at Virginia Military Institute, an honored tradition where cadets receive their class ring. She also worried about being able to be there for her daughter’s class ring ceremony at her high school. Despite the challenges from cancer treatments, she ultimately made it to both ceremonies to see her children’s milestones.

And on March 2023, she underwent her procedure at Hume-Lee Transplant Center. After removing her liver, Kumaran and Seung Duk Lee, M.D., worked at a table to remove the cancerous tumor from the viable part of her liver as David Bruno, M.D., performed a bypass procedure to keep blood flowing through her body around the area where her liver had been. Bruno reattached blood vessels and patched her vena cava along with Adrian Cotterell, M.D., who also reattached bile ducts.

This procedure is only one example of the innovative work being done by Hume-Lee to treat HCC more effectively. Recently, Lee and his research team were awarded funds to propel new developments in technology to deliver targeted therapy to treat liver cancer. Bruno, director of Hume-Lee Transplant Center, is immensely proud of the pioneering techniques being used by his team to save the lives of more patients.

“We are providing advanced liver cancer patients a chance at a cure which was previously unimaginable. This innovative approach reflects our commitment to expanding the boundaries of what’s possible in transplant,” Bruno said.

More than a year later, Heather’s greatly reduced liver has regrown to close its original size due to the liver’s amazing ability to regenerate itself.

Scans show Heather’s liver is cancer-free, yet she will continue testing for years to ensure that remains the case. Kumaran estimates she has an 80 to 90% chance that the cancer won’t return.

Since the procedure, the Chesapeake mom has seen her son graduate from VMI in May 2024, and she was also there for her daughter’s high school graduation less than a month later.

The tattoo on her right hand is still a conversation starter, including with doctors not involved in the procedure who marvel at a liver transplant patient who’s not on immunosuppressant drugs to avoid organ rejection (since she received her own liver).

“I was given a gift,” Heather said. “Anytime anybody asks me about my tattoo or somebody talks about cancer, I love sharing my story.”