What are the treatment options for hepatocellular carcinoma?

Hello,

Welcome to icliniq.com.

I have seen the attached reports (the attachment was removed to protect the patient's identity), but it does not show the complete set. To decide what therapies could be offered, I specifically need to see the following:

• Serum bilirubin level.
• Serum albumin level.
• PT (prothrombin time ) or INR (international normalized ratio).
• Recent CT (computed tomography) scan of the abdomen.
• Patient's clinical status (whether or not he has ascites or encephalopathy).

Even with the given picture, if the things mentioned above are within normal or good ranges, we can offer the following:

• Local or ablative therapies.
• Immunotherapy combinations.

Please share the above information, and we can discuss what can be done further.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.

Hello,

Hope to hear from you soon.

Best regards.

Hello,

Welcome back to icliniq.com.

The shared laboratory reports show raised bilirubin levels, and a big chunk of it is direct bilirubin, which might be due to obstruction of normal bile channels due to the tumor. The CT (computed tomography) scan will clarify things in this regard.

If PT (prothrombin time) or INR (international normalized ratio) becomes normal, ascites become negative, and the patient does not have encephalopathy; we can consider a variety of targeted therapies. The best way forward from here is to acquire the remaining investigation results, namely:

• PT (prothrombin time) or INR (international normalized ratio).
• CT (computed tomography) abdomen.
• Patient’s clinical status and assessed consciousness level.

I hope this is clear, and if you have any questions, do not hesitate to ask.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have studied the reports attentively. They show that the patient’s liver is failing. To treat hepatocellular carcinoma (HCC), we need to have a partly functioning liver. But in this case, we do not have that.

From surgery to local or ablative treatments to systemic therapies, the patient will not be able to tolerate anything with such poor liver health.

What can we offer in this condition? That is the actual question now. This is my opinion:

• The patient should be given fresh frozen plasma and vitamin K.
• The patient should be given L-ornithine L-Aspartate infusion.
• The patient should receive respiratory support if having poor oxygen saturation due to lung metastasis.
• The patient should receive stool softeners.
• The patient should receive the tablet Carvedilol for portal hypertension.
• The patient should be given an antiemetic and PPI (proton pump inhibitor).
• The patient should receive a good analgesic.

Palliative care physicians and gastroenterologists should give all this to make the patient as comfortable as possible.

Thank you.