Epithelioid haemangioendothelioma: the decisions you may face
3 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Asymptomatic, stable, multifocal
Active surveillance with imaging every three to six months; treat only on progression or symptoms.
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
- Avoids incontinence and erectile dysfunction of treatment in men who would never be harmed
- Level-1 evidence of safety (ProtecT)
A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.
- Fast, ubiquitous
- Sub-millimetre resolution
- Standard for RECIST response
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
- No ionising radiation
- Best soft-tissue and brain imaging
- Functional sequences (diffusion, perfusion)
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Anxiety and adherence
- Repeat biopsies
- Under-used outside high-income countries
- Anatomic only; cannot distinguish scar from live tumour
- Radiation dose
- Poor for brain, marrow, and small peritoneal disease
- Slow and expensive
- Motion artefacts
- Gadolinium concerns in renal impairment
- Between Active surveillance, CT (computed tomography) and MRI, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (asymptomatic, stable, multifocal), which of the standard options do you recommend and why?Why: Guideline options include: Active surveillance with imaging every three to six months; treat only on progression or symptoms.
Add these to your appointment list, or take the full question set for this cancer.
Localised
Complete resection; liver transplantation for unresectable liver-limited disease; radiotherapy for bone lesions.
Removing a bone or soft-tissue sarcoma while keeping the arm or leg, rebuilding with metal implants, bone grafts or growing prostheses in children.
- Preserves function without compromising survival
- Custom implants for pelvis and spine
Replacing the whole diseased liver cures both the cancer and the cirrhosis underneath it, for patients whose tumours are small enough.
- Only therapy that treats cancer and cirrhosis together
- Best long-term survival for early HCC
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Implant infection and mechanical failure over decades
- Requires specialist sarcoma centres
- Organ shortage and waiting-list dropout
- Lifelong immunosuppression; checkpoint inhibitors before transplant risk rejection
- Low-dose bath to normal tissue
- Motion management
- Between Limb-salvage surgery and endoprosthetic reconstruction, Liver transplantation for cancer (Milan criteria and beyond) and IMRT / IGRT (modern external beam), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (localised), which of the standard options do you recommend and why?Why: Guideline options include: Complete resection; liver transplantation for unresectable liver-limited disease; radiotherapy for bone lesions.
Add these to your appointment list, or take the full question set for this cancer.
Progressive or symptomatic
Sirolimus or another mTOR inhibitor first; pazopanib or other anti-angiogenic kinase inhibitors; anthracycline chemotherapy for rapidly progressive disease.
An mTOR-blocking pill that doubled progression-free time with exemestane in 2012 and is now paired with the oral SERD giredestrant.
Fyarro is an infusion of the transplant drug sirolimus packaged in albumin particles. It is the first approved treatment for malignant PEComa, a rare soft-tissue tumour driven by loss of the TSC genes.
Pazopanib is the only multi-kinase inhibitor approved for soft-tissue sarcoma (excluding fat-derived tumours), used after chemotherapy fails.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Avoid grapefruit. Live vaccines are contraindicated.
- 7.5 mg (mild), 5 mg (moderate), 2.5 mg (severe).
- Take on an empty stomach (1 hour before or 2 hours after food).
- Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- 200 mg daily in moderate impairment; avoid in severe.
- Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
- Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
- Between Everolimus, Sirolimus protein-bound particles, Pazopanib and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (progressive or symptomatic), which of the standard options do you recommend and why?Why: Guideline options include: Sirolimus or another mTOR inhibitor first; pazopanib or other anti-angiogenic kinase inhibitors; anthracycline chemotherapy for rapidly progressive disease.
- Am I a candidate for Everolimus, Sirolimus protein-bound particles, Pazopanib or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.