Advanced Hepatocellular Carcinoma

Case Report

Austin J Gastroenterol. 2017; 4(3): 1088.

Advanced Hepatocellular Carcinoma

Soldera J1,2*, Balbinot SS1,3, Balbinot RA1,3, Furlan RG4 and Terres AZ4

1Clinical Gastroenterology, Faculty of Medicine of Universidade de Caxias do Sul, Brazil

2Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil

3Universidade de São Paulo, Brazil

4Department of Gastroenterology, Hepatology and Digestive Endoscopy of Hospital Geral de Caxias do Sul, Brazil

*Corresponding author: Jonathan Soldera, Clinical Gastroenterology, Faculty of Medicine of Universidade de Caxias do Sul, Brazil

Received: July 19, 2017; Accepted: August 08, 2017; Published: September 25, 2017


Each year, hepatocellular carcinoma is diagnosed in over half a million people worldwide. In this paper, it is reported the case of a patient with a late diagnosis of advanced hepatocellular carcinoma, with poor prognosis. It was used Barcelona-Clínic Liver Cancer protocol for diagnosis, staging and management. Understanding diagnosis and therapeutic approach to this disease is essential, especially if we keep in mind the quintessential basis of prevention and early detection.

Keywords: Hepatocellular carcinoma; Cirrhosis; Palliative care


Hepatocellular carcinoma (HCC) is diagnosed in over half a million people worldwide every year [1]. It has become 5th most common cancer in men and the 7th in women. The burden of this disease is highest in developing countries, where hepatitis B is still endemic: Southeast Asia and Sub-Saharan Africa [2]. Although its incidence is rising worldwide and new therapies have been developed, the 5-year survival rate is still low. In the United States, it has remained below 12% [3].

Since it is highly prevalent in patients with cirrhosis or advanced fibrosis, screening with an ultrasonography (US) each 6 months is recommended as standard-of-care: early diagnosis means more effective treatment and increased survival. The measurement of serum alpha-fetoprotein levels remains controversial due to its low sensitivity and is not widely recommended currently [4]. A Chinese study showed that the combination of US and measurement of alphafetoprotein translates into a 37% reduction in mortality due to HCC [5].

The objective of this paper is to report the management of a case of locally advanced HCC.

Case Presentation

Male patient, 68-years-old, was referred from a small city hospital to ours to investigate jaundice, weight loss and a liver nodule with portal venous thrombosis (PVT) identified in a prior US. He had a previous diagnosis of cirrhosis due to alcohol after an episode of alcoholic hepatitis fifteen years earlier. He was lost to follow-up by his won will afterwards, because of clinical improvement and abstinence. He was admitted with a poor general condition, with overt hepatic encephalopathy (West-Haven 3) [6], ascites and jaundice. Laboratory creatinine 2.2 g/dL, pallets 193,000/mm³, INR 1.25, Hemoglobin 14, 7 g/dL, Leukocytes 9,970/mm³, total bilirubin 17.2 g/dL, albumin 3.09 g/dL. Child-Pugh classification C [7]. A diagnostic and therapeutic paracentesis was performed, with neutrophil count compatible with spontaneous bacterial peritonitis. It was ordered a dynamic contrasted enhanced magnetic resonance imaging (DCE-MRI) and it was began treatment with piperacillin-tazobactam, lactulose and albumin infusion, with no improvement of his general condition. Five days later, he presented hematemesis and an upper digestive endoscopy was performed, with small esophageal varices and duodenal ulcers Forrest IIc [8]. MRI showed moderate ascites and a heterogeneous liver with multiple nodules, some with pseudo-capsules and a PVT, suggesting locally advanced HCC with malignant PVT (Figures 1-4). He was therefore diagnosed with HCC staging Barcelona-Clinic Liver Cancer (BCLC) D [4]. Palliative care was discussed with the family, and although with some resistance, it was began. He died after thirteen days of the hospital admission, in the infirmary, with his family, receiving opioids to attenuate suffering.