A 64-year-old man with Child A liver cirrhosis with no history of decompensation. After detection of a focal hepatic lesion on screening ultrasound, the study is completed with a thoracoabdominal CT scan. This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarcinoma, tumor vascular invasion and a metastasis in the right adrenal gland. No ascites is observed. The patient reports only asthenia, but no general syndrome. The treatment of this patient would be:
Comment: The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptomatic and supportive at this stage would not be the right thing to do. TACE would not be indicated because of extrahepatic involvement. Transplantation would also not be done if he has extrahepatic disease. We are left with answers 3 and 4, both with systemic treatment (indicated because it is metastatic) and the correct answer is 4, for all the reasons given therein.
Symptomatic and supportive treatment, since he presented an advanced hepatocarcinoma with vascular invasion and metastasis.
Transarterial chemoembolization (TACE), since the treatment increases survival in patients with advanced hepatocarcinoma.
Systemic chemotherapy with doxorubicin iv since he presents disseminated disease but he is in good general condition.
Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C.
The appropriate treatment is liver transplantation as it is the only procedure that completely eliminates the primary tumor and avoids future complications of cirrhosis.
The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptomatic and supportive at this stage would not be the right thing to do.
TACE would not be indicated because of extrahepatic involvement.
both with systemic treatment (indicated because it is metastatic) and the correct answer is 4, for all the reasons given therein.
both with systemic treatment (indicated because it is metastatic) and the correct answer is 4, for all the reasons given therein.
Transplantation would also not be done if he has extrahepatic disease.