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HomeAnswersMedical oncologyhepatocellular carcinomaMy friend has hepatitis B and has progressed to thrombosis. Help.

What are the treatment options for hepatocellular carcinoma?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At January 5, 2023
Reviewed AtOctober 17, 2023

Patient's Query

Hi doctor,

My friend has tested positive for the hepatitis B virus. He has a cirrhotic liver, and hepatocellular carcinoma has spread to cause a malignant portal vein thrombosis. His doctors are saying that there is nothing to be done and that other than HBV medications, there are no treatment options.

Kindly help.

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.

Thank you.

The Probable causes

Hepatitis B cirrhosis.

Investigations to be done

Serum bilirubin and albumin, PT (prothrombin time) or INR (international normalized ratio), CT (computed tomography), multiphasic abdomen, consciousness status.

Patient's Query

Hello doctor,

We will gather all the above tests and share them with you soon.

Thank you.

Hello,

Hope to hear from you soon.

Best regards.

Patient's Query

Hi doctor,

Please note we cannot do the CT scan for another two weeks. So we will have it after two weeks. Please give me your feedback on these tests in addition to the previously submitted tests, and let me know if you have any recommendations for moving forward.

Thank you.

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.

Best regards.

Patient's Query

Hi doctor,

These are the remaining test results (attachments removed to protect the patient's identity).

I hope to hear back from you soon.

Thank you.

Hello,

Welcome back to icliniq.com.

I have studied the reports attentively. They show that 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 anti-emetic and PPI (proton pump inhibitors).
  • 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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Uzair Ali
Dr. Muhammad Uzair Ali

Medical oncology

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