Nicholas Nissen, MD: Next Steps for Jose
Nicholas Nissen, MD
Published Online:Jun 18, 2015
Jose V is a 73-year-old Filipino store owner from Queens, New York, with a history of chronic hepatitis B (HBV) infection and unresectable hepatocellular carcinoma (uHCC).
Unresectable Hepatocellular Carcinoma: case 1
Unresectable Hepatocellular Carcinoma: case 1
Unresectable Hepatocellular Carcinoma: case 2
Unresectable Hepatocellular Carcinoma: case 3
The goal is the eradication of the tumor. TACE of a large lesion such as this is unlikely to be curative, because there would most likely be residual tumor in the lesion. Therefore, Jose will need to be monitored closely for any sign of local radiographic progression.
CASE 1: Unresectable Hepatocellular Carcinoma
Jose V is a 73-year-old Filipino store owner from Queens, New York, with a history of chronic hepatitis B (HBV) infection and unresectable hepatocellular carcinoma (uHCC).In May 2014, patient was referred to a hepatologist with an elevated ALT (68 IU/mL)
- Medical history includes type II diabetes, previously treated with metformin and a sulfonylurea; currently controlled with diet and exercise regimen; other MH was unremarkable
- Family history was relevant for a sister who was diagnosed with HCC and chronic HBV infection at age 60
- No symptoms of liver disease were noted; patient had mild tenderness over the right upper quadrant
- Ultrasound revealed a hyperechoic lesion in the left lobe; MRI with gadolinium showed an 11-cm mass in the left lobe with imaging characteristics consistent with HCC. No evidence of metastatic disease was noted on bone scan and uncontrasted CT scan of the chest.
- Based on laboratory findings and clinical features, the patient was determined to have Child Pugh Class A, with a MELD score of 8
- Consultation with the multidisciplinary team recommended surgical resection, however patient was fearful of surgery and opted for TACE procedure
