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Abstract: A 67-year-old elderly patient presented with pain and discomfort in the right upper abdomen with wasting for more than 2 months, along with nausea and loss of appetite. After perfect examination, the patient was found to be a patient with chronic hepatitis B. The abdominal CT suggested the presence of a large tumor in the right liver, which was finally diagnosed as cirrhosis and hepatocellular carcinoma caused by chronic viral hepatitis. After TACE intervention with comprehensive anti-tumor therapy, the patient was in remission and the current tumor treatment was effective.
[Basic information] Male, 67 years old
Disease Type】Cirrhosis and hepatocellular carcinoma caused by chronic viral hepatitis
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan] TACE intervention + oral medication (entecavir dispersible tablets + lenvatinib mesylate capsules + injectable karilizumab + diammonium glycyrrhizate capsules + ursodeoxycholic acid capsules)
Treatment period】2 months of comprehensive treatment
Treatment effect] The tumor began to shrink gradually, the tumor markers also gradually decreased, and the disease was also in remission
I. Initial consultation
The patient, male, 67 years old, reported that he had pain and discomfort in the right upper abdomen with weight loss for about 2 months, and recently lost his appetite and weight by about 10 kg in 2 months. The patient was given routine blood tests, liver function and abdominal ultrasound. The routine blood tests revealed that the patient was mildly anemic, and the liver function also indicated an increase in transaminases and a decrease in albumin levels. At present, the patient is in a state of chronic wasting, and the abdominal ultrasound indicates multiple occupancies in the liver and a large tumor in the right liver. According to the current examination, the patient needs to be further admitted to the hospital to improve the intensive abdominal CT examination to assess the current condition and then decide the next treatment, and the patient was admitted to the hospital.
II. Treatment process
After admission, the patient was screened for hepatitis B virus, and the results showed that the patient was a small triple positive hepatitis B. Meanwhile, the intensive abdominal CT examination indicated that the patient’s liver showed cirrhotic changes, and the tumor in the right liver was about 15 cm in diameter, with local diaphragmatic abdominal wall invasion, lymph node metastasis in the hilar region, and suspicious metastatic nodes could be seen in the abdominal cavity. At present, the patient’s condition can be basically identified as cirrhosis and hepatocellular carcinoma caused by chronic viral hepatitis, which is currently in the advanced stage of liver cancer. At present, the patient’s condition is not suitable for surgery, but can be treated by comprehensive anti-tumor therapy. After communicating with the patient’s family, the patient’s family expressed their understanding and firstly gave the patient entecavir dispersible tablets for anti-hepatitis B virus treatment, and gave the patient TACE anti-tumor interventional therapy, and at the same time combined with targeted plus immunotherapy. At the same time, the patient was treated with diammonium glycyrrhizinate capsule and ursodeoxycholic acid capsule orally to protect liver and bile.
III. Treatment effect
After the patient was treated with antiviral, hepatoprotective and biliary therapy, the patient’s liver function gradually improved, transaminases decreased, the patient’s digestive function also gradually recovered, and the amount of food intake began to increase. After the patient’s general condition improved, interventional therapy, targeted therapy and immunotherapy were given at the same time. After about 2 months of treatment, the patient’s intensive CT was reviewed again and found that the patient’s tumor volume was shrinking, the liver cancer tumor marker alpha-fetoprotein was also significantly decreased, and the metastatic lymph nodes in the abdominal cavity were also reduced. At present, the patient’s anti-tumor treatment is effective. The patient is very satisfied with the treatment effect and requests to continue the current comprehensive anti-tumor treatment and return to the hospital for review every 2 weeks.
IV. Notes
We are glad that the patient’s condition is under control, but we need to additionally advise the patient that he should pay attention to the light diet, because at present the patient’s liver function is not good and the digestive function is weak, so greasy food will easily cause indigestion and abdominal distension. The patient can eat more nutritious food, such as lean meat, fish, milk, etc., and fresh fruits and vegetables to supplement the necessary vitamins.
In addition, at present, the patient belongs to the stage of comprehensive anti-tumor therapy, the tumor may become necrotic, so it may cause fever and abdominal infection, etc. Targeted immunotherapy may also have adverse reactions such as bone marrow suppression, hypothyroidism, cardiovascular nervous system damage, rash, etc. Therefore, it is suggested that the patient should return to the hospital for review once every 2 weeks.
V. Personal insight
However, with the development of comprehensive anti-tumor therapy, the emergence of various targeted drugs and immunotherapy drugs, and the progress of various clinical studies, there are many drugs for comprehensive treatment of hepatocellular carcinoma, which may have certain therapeutic effects to reduce patients’ pain and prolong their life span. This patient has also obtained better therapeutic effect through integrated anti-tumor therapy such as interventional therapy, targeted therapy and immunotherapy, which hopefully will be helpful to other patients.