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Hepatocellular Carcinoma Case Studies

Case Studies: Unresectable HCC with Extrahepatic Involvement

Catherine Frenette, MD, discusses the diagnosis, treatment, and outcome of a 77-year-old man who presented with BCLC stage C, unresectable HCC and extrahepatic involvement.

Unresectable HCC with Extrahepatic Involvement

A 77-Year-Old Male With Unresectable HCC and Extrahepatic Involvement

  • History and physical exam
    • An otherwise healthy, 77-year-old Caucasian male with a history of alcohol use
    • Presented to his PCP complaining of abdominal pain, fatigue and an unexplained 10-lb weight loss
    • Currently consumes 3-4 alcoholic drinks per day
    • ECOG PS 0
  • Imaging
    • CT scan: 4.5-cm hepatic lesion with arterial hypervascularity, portal venous washout, and a pseudocapsule indicative of hepatocellular carcinoma; no evidence of vascular invasion
    • Bone scan: left-sided iliac mass (3.1 cm)
    • Chest CT: clear
  • Diagnosis: unresectable HCC with extrahepatic involvement
    • BCLC stage C
    • Child-Pugh A
    • AFP Level: 3548.4 ng/mL
    • Weight: 72 kg
  • Lenvatinib 12 mg QD was initiated.
    • He experienced modest weight loss and reported loss of appetite for which he was referred for nutritional therapy
    • Imaging at 16 weeks: partial response (0.5 cm)
    • 8 months after initiation of therapy: treatment discontinued due to disease progression
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