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- Sat Nov 15, 2008 8:50 am
Hi. This is regarding my brother-in-law, a 59 year old male.
He was diagnosed with hepatitis C and liver cirrhosis years ago.
He has been in and out of hospitals ever since. Location Cairo, Egypt.
Last week he threw up a large amount of blood and had a high AFP reading over 1,000. All this happen while in the hospital; he is still in hospital at this time.
My question is, based on his latest medical test below, what type of treatment, if any would be recommended at this point.
I think that his doctor is suggesting Radiofrequency Ablation. I say "think" based on the doctor telling the family that they want "to go in and iron cells…". I am awaiting confirmation on the medical term of this "ironing" from his doctor.
Thank you for your time and for being available to us on this forum. I appreciate your opinions and many thanks again.
- Axial CT abdominal. CT scan was performed after bowel opacification and intra venous contrast injection.
- The liver is moderate enlarged cirrhotic coarse pattern. The right lobe posterior segment is the seat of heterogeneous enhanced mass lesion measuring 11 x 12 x 9 cm. Extends to segment 6, 7 and to lesser extent 8 with visceral surface buldge.
- Portal vein is homogeneously enhanced.
- No intra hepcetic biliary rodicles dilation.
- Spleen is moderate enlarged, homogeneous in attenuation with regular surface.
- Multiple para esophageal collateral and varies.
-Kidneys are average size, of homogeneous attenuation pattern and adequate excretory function. No focal mass lesion.
- Pancreas, supra renal glands are average size, regular margins, with homogeneous attenuation pattern of the parenchyma. No focal mass lesion.
- No para aortic or retro peritoneal lymphadenopathy or mass lesion.
- No ascites or localized collection.
- The scanned lung bases and pleural recess are clear.
- Hepatomegaly with right lobe (6-7 and 8) mass lesion likely neoplastic.
- Splenomegaly and para esophageal collaterals and varices.
| Dr. Tamer Fouad
- Tue Feb 03, 2009 8:11 am
I do apologize for the late reply. I hope your brother in law is well.
The most important determinant for the treatment of hepatocellular carcinoma (HCC) is the liver function status. Since the most important risk factor for this disease is cirrhosis and hepatitis C (which is endemic in Egypt), HCC usually presents with poor liver function.
Many oncologists use one of several prognostic classifications that assess liver function to determine the best therapeutic approach.
Surgery as you know would be the optimal treatment. Liver transplant is another option with excellent outcome but requires strict criteria which do not apply to your father. The presence of varicies that you mention is quite significant as it indicates the presence of portal hypertension which is usually a contraindication for curative approaches.
Radiofrequency ablation is a great option for local disease in which neither surgery nor transplant is possible. Best results are acquired when the tumor size is less than 4cm. This is due to two reasons 1, the applicator has a circumference of approximately 5cm and of course smaller tumors fair better than larger ones. In this setting the outcomes are comparable to surgery. However, there is no strict limitation on size and multiple sessions can be used to cover the area occupied by the tumor although less benefit is expected.
HCC is a very difficult disease to treat because of the aforementioned reasons. Localized HCC always challenges the oncologist to take a more active attempt at its control.
Please keep us updated and my apologies again for the late response.
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