would monitor a patient every 3 months for 2 years and then every 6 months from then on. Most local recurrences will be evident within 12 months, but some can occur later, which is why frequent postresection surveillance continues to 2 years.
Generally, Dr. Nissen
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
Gholam Analyzes Treatment Outcomes for Advanced HCC in Child-Pugh B Population
April 28th 2024During a live Community Case Forum event in partnership with the Tennessee Oncology Practice Society, Pierre Gholam, MD, examined the current state of treatment for patients with hepatocellular carcinoma, looking in particular at what data is available for those with Child-Pugh B and C status who have poorer outcomes and have limited data from prospective clinical trials.
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