gastrointestinal malignancies/hepatocellular carcinoma

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683d0d64c1b3f4bd827da718

Oncology

gastrointestinal malignancies

hepatocellular carcinoma

Case History

A 47-year-old man with a chronic history of alcohol use and intravenous drug abuse, known to have hepatitis C infection, is admitted to the general medical ward from the emergency department. He presents with several months of progressive fatigue, unintentional weight loss, and diffuse abdominal discomfort, which he initially attributed to his living circumstances. Physical examination reveals a frail and ill-appearing individual with temporal wasting, a distended abdomen with shifting dullness, and mild scleral icterus. His vital signs upon admission were stable: temperature 36.70C, blood pressure 114/64 mmHg, pulse 77/min, respirations 12/min, and oxygen saturation 98% on room air. Imaging studies performed in the emergency department, including a contrast-enhanced CT scan of the abdomen, revealed multiple large, enhancing masses within the liver consistent with hepatocellular carcinoma, in the setting of cirrhotic changes. Given this patient's clinical presentation, extensive liver disease, and confirmed imaging findings, what is the most appropriate initial management strategy, and what critical complication should be closely monitored?

Lab Parameter	Value	Reference Range
Hemoglobin	125 g/L	130-170 g/L
Hematocrit	0.38	0.40-0.54
Leukocyte count	7.5 x 10^9/L	4.0-11.0 x 10^9/L
Platelet count	95 x 10^9/L	150-450 x 10^9/L
Na+	139 mmol/L	135-145 mmol/L
Cl-	102 mmol/L	98-107 mmol/L
K+	3.7 mmol/L	3.5-5.0 mmol/L
HCO3-	25 mmol/L	22-30 mmol/L
BUN	8.6 mmol/L	2.5-7.1 mmol/L
Glucose	3.7 mmol/L	3.9-6.1 mmol/L
Creatinine	115 5mol/L	60-110 5mol/L
Ca2+	2.55 mmol/L	2.10-2.55 mmol/L
Alpha fetoprotein	470 ng/mL	< 10 ng/mL
AST	65 U/L	10-40 U/L
ALT	67 U/L	7-56 U/L
Albumin	28 g/L	35-50 g/L
INR	1.8	0.8-1.2

A ) Initiate comprehensive palliative care and manage symptoms of hepatic encephalopathy.

B ) Proceed with urgent surgical hepatectomy and monitor for post-operative acute liver failure.

C ) Plan for transarterial chemoembolization (TACE) or radioembolization (TARE), and closely monitor for acute tumor rupture with hemoperitoneum.

D ) Start systemic targeted therapy with lenvatinib or sorafenib and screen for large esophageal varices.

E ) Enroll in an alcohol cessation program and schedule outpatient follow-up with serial alpha-fetoprotein levels and liver ultrasound surveillance.

Edit question

Lab Parameter	Value	Reference Range
Hemoglobin	105 g/L	120-150 g/L
Leukocyte count	10.5 x 10^9/L	4.0-11.0 x 10^9/L
Platelets	145 x 10^9/L	150-400 x 10^9/L
Serum Creatinine	88 µmol/L	53-106 µmol/L
Glucose	5.2 mmol/L	3.9-6.1 mmol/L
Lipase	40 U/L	13-60 U/L
Alpha-fetoprotein level	680 ng/mL	<20 ng/mL
Total bilirubin	25 µmol/L	5-21 µmol/L
Alkaline phosphatase	200 U/L	30-120 U/L
Aspartate aminotransferase (AST)	40 U/L	10-40 U/L
Alanine aminotransferase (ALT)	55 U/L	7-56 U/L
Albumin	32 g/L	35-50 g/L
INR	1.3	0.8-1.2

Lab Parameter

Value

Reference Range

Hemoglobin

105 g/L

120-150 g/L

Leukocyte count

10.5 x 10^9/L

4.0-11.0 x 10^9/L

Platelets

145 x 10^9/L

150-400 x 10^9/L

Serum Creatinine

88 µmol/L

53-106 µmol/L

Glucose

5.2 mmol/L

3.9-6.1 mmol/L

Lipase

40 U/L

13-60 U/L

Alpha-fetoprotein level

680 ng/mL

<20 ng/mL

Total bilirubin

25 µmol/L

5-21 µmol/L

Alkaline phosphatase

200 U/L

30-120 U/L

Aspartate aminotransferase (AST)

40 U/L

10-40 U/L

Alanine aminotransferase (ALT)

55 U/L

7-56 U/L

Albumin

32 g/L

35-50 g/L

INR

1.3

0.8-1.2