Unresectable Hepatocellular Carcinoma: case 2 - Episode 5

Pierre Gholam, MD: Recommended Screening

Diagnosing hepatitis C has become an increasing priority on both the public health level and also on the individual physician level. Recently, the Centers for Disease Control and Prevention (CDC) issued guidelines for the screening of individuals born between 1945 and 1965, regardless of whether or not they have a risk factor for hepatitis C. This is because advances in the treatment of hepatitis C have made it an easily treated disease that can be treated with oral therapy with a high cure rate. Doing this potentially limits or eliminates the downstream complications of hepatitis C including both cirrhosis and liver cancer.

CASE 2: Unresectable Hepatocellular Carcinoma

Steve C is a 56-year-old Caucasian construction worker from Miami, Florida with a history of chronic hepatitis C virus (HCV) infection and alcohol abuse.

In January of 2013 the patient was diagnosed with unresectable hepatocellular carcinoma, with an encapsulated, 7-cm tumor identified in the right lobe on Gadolinium-enhanced MRI

Multidisciplinary team recommended TACE because of patient’s ongoing alcohol use, and patient achieved a partial response (>30% decrease by RECIST criteria)

In April 2014, the patient returns for follow up

Patient’s lab values include:

AFP: 1100 ng/mL; AST 322 IU/L

ALT: 195 IU/L

Total bilirubin: 1.8 mg/dL

Platelets: 85,000

At his current workup, the patient is classified as Child Pugh Class A, with a MELD score of 13; ECOG PS is 1

MRI with gadolinium is consistent with disease progression, with encapsulated lesion in the right lobe measuring 9 cm, consistent with HCC

A third TACE procedure is recommended by the MDT

Following the TACE procedure, imaging results show 65% necrosis in the treated area with residual 1.5-cm nodules