What is it about?
Our patient was diagnosed at an early stage with a solitary lesion for which potentially curative treatments (surgical resection, ablation, or liver transplantation) could be offered. However, the condition progressed to an advanced stage with extrahepatic metastasis to be categorized as BCLC stage C, so the patient received the systemic therapy as the first therapeutic option. Notably, active gastrointestinal bleeding required the discontinuation of systemic therapy, per the patient's preference. Therefore, it was a great challenge to tailor appropriate therapies other than those listed in the guidelines for BCLC stage C. However, the small well-defined HCC lesion, preserved liver function, good patient performance status, and the patient's preferences resulted in a good therapeutic response.
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Photo by Kelli McClintock on Unsplash
Why is it important?
Hepatocellular carcinoma (HCC) is a common primary liver malignancy that mainly occurs in chronic liver disease patients with underlying cirrhosis. HCC incidence has increased globally in the last two decades. The incidence is expected to increase until 2030 in certain geographical regions, mainly Asia and Africa.
Perspectives
On the basis of this case, we concluded that the clinical decision-making and treatment recommendations by the multi-disciplinary board should not rely only on a simplified algorithm comprising tumor burden, liver function, and the presence of related symptoms. The ultimate decision should involve a complex process comprising the integration of all data, with the individual patient's medical profile, as part of the multi-disciplinary team approach to tailor the ideal management.
Lecturer Nourhan Badwei
Ain Shams University
Read the Original
This page is a summary of: HCC case management-related challenges: Think outside the box!, iLiver, September 2023, Elsevier,
DOI: 10.1016/j.iliver.2023.08.001.
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