Unresectable Hepatocellular carcinoma with Amit Singal, MD and Richard Finn, MD
CASE 1: Unresectable Hepatocellular Carcinoma (uHCC)
Mario C is a 74-year-old retired steel worker from Allentown, Pennsylvania. His past medical history is notable for hepatitis B virus (HBV) infection (diagnosed in early 1990s).
In July 2013, patient was referred to a hepatologist with an elevated ALT (70 IU/mL) and AST (53 IU/mL).
Medical history is also notable for mild hypertension (currently controlled on antihypertensives) and hypercholesterolemia (currently controlled with diet); patient denies any alcohol use
Family history was relevant for an older brother who died of HCC and chronic HBV infection at age 70
On physical exam, no evidence of liver disease was noted and patient did not report any recent weight loss; patient reported some intermittent abdominal pain and there was mild tenderness in the lower right quadrant on palpation
Ultrasound revealed a poorly defined mass in the right lobe; contrast enhanced MRI showed a 12-cm mass in the lower right segment consistent with HCC and several smaller nodules. Bone scan and chest CT showed no evidence of metastatic disease
Patient presented to the Multidisciplinary Team (MDT) with Child Pugh Class A, with a MELD score of 7; patient’s performance status was 1
On surgical consult, the patient was deemed unresectable and the MDT recommended a TACE procedure for the larger lesion
In December of 2014, evidence of residual disease was detected on a follow up CT scan at the site of the first TACE procedure; smaller nodules also showed evidence of radiologic progression.
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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