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Hepatocellular Carcinoma Case Studies

Pierre Gholam, MD: Alcohol Abuse Impact on Treatment

Pierre Gholam, MD
Published Online:Jun 18, 2015
Dale P is a 61-year-old Jamaican-American male from Houston, Texas, with a history of HCV infection and cirrhosis, who works in corporate cell-phone sales.

Unresectable Hepatocellular Carcinoma: case 3

Alcohol abuse not only affects the likelihood of progression of liver disease but, in persons who have advanced fibrosis or cirrhosis, it also independently increases the risk of liver cancer. Alcohol use or abuse often makes it more difficult to tolerate treatment, so it not only affects progression of disease, it also affects patients' adherence to care ability to tolerate treatment. When patients have advanced fibrosis or cirrhosis, they should be advised to commit to lifelong sobriety or, if they are incapable of doing that, to restrict alcohol consumption to a very occasional minimum. Alcohol abuse in itself is not a contraindication for offering patients therapy, with the one notable exception of liver transplant.

CASE 3: Unresectable Hepatocellular Carcinoma

Dale P is a 61-year-old Jamaican-American male from Houston, Texas, with a history of HCV infection and cirrhosis, who works in corporate cell-phone sales.

In February of 2012 the patient presented with upper right quadrant discomfort; CT scan showed the presence of a 4.1 × 3.9-cm mass consistent with HCC in the setting of cirrhosis; he was referred to the multidisciplinary team for further assessment.
  • Initial assessment showed a MELD score of 7 and Child Pugh A class
  • The patient was not considered appropriate for transplant based on prior history of successfully treated renal cancer (4 years prior) and patient declining to pursue a transplant evaluation
  • Medical history notable for heavy alcohol use and substance abuse approximately 30 years ago, stroke in mother, deep vein thrombosis in father
  • Other medical history included nonresponse to pegylated interferon and ribavirin for HCV 5 years earlier; current medications included antihypertensives and aspirin
  • Patient recommended for liver resection in April 2012
  • He underwent R0 resection. Pathology showed moderately differentiated HCC with negative margins and no evidence of microvascular invasion
  • On follow up in April 2013, patient shows no evidence of disease recurrence on MR which is performed every 3 months
On follow up in August of 2014, ~2 years post resection, there is imaging evidence of recurrence and metastasis.
  • MRI detects multiple lesions at the postsurgical site, largest ~1.7 cm, and a nodule in the inguinal lymph node, ~1.9 x 1.0 cm
  • Patient’s current assessment shows a MELD score of 9 and Child Pugh A
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