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Abstract: The patient had a long past history of hepatitis B. He presented with unexplained malaise, poor appetite, and weight loss, and was found to have hepatitis B at the age of about 30 without treatment. After seeking medical attention, biochemical tests, CT and MRI revealed the presence of a tumor on the liver with high suspicion of hepatocellular carcinoma. The patient was given surgery + medication. The surgery was successful and the tumor was completely removed, and no tumor recurrence was seen during the patient’s review.
Basic information】Male, 58 years old
Disease Type】Hepatocellular carcinoma
Hospital】Hunan Provincial People’s Hospital
Date of consultation】December 2021
Treatment plan】Surgery (left hepatic lobectomy) + medication (entecavir tablets, lenvatinib mesylate capsules, Sophora granules)
Treatment Period】Hospitalization for 12 days, regular review
Effectiveness of treatment】Tumor was completely resected, and no tumor recurrence was seen in the review.
I. Initial consultation
The patient had a history of hepatitis B for more than 30 years. The patient described: half a month ago, he developed weakness with no obvious cause, and felt weak when he did some housework. He came to the hospital for biochemical tests, CT and MRI examinations, and found that: the white globule ratio was 1.31ng/mL, and a tumor was found on the liver, which was highly suspected to be hepatocellular carcinoma from the consideration of imaging features, with a size of about 10.8*6cm, located in the left outer lobe of the liver, and no obvious tumor was found in the rest of the liver. The liver as a whole showed cirrhosis, but the liver function was good and at grade A. Hepatitis B virus DNA quantification was elevated.
(CT examination report)
(Biochemical examination report)
II. Treatment process
After understanding the patient’s condition, anti-hepatitis B virus treatment was first administered, and the patient was given entecavir tablets for oral administration. After assessing the patient’s general physical condition and liver function, he could tolerate surgical treatment, and carefully analyzed the MRI images, and found that the tumor did not invade important large blood vessels, and the tumor was at an early stage, so surgery could be done. The patient’s family considered that it was already cancerous and did not want her father to suffer the pain of surgery, but explained the condition and the necessity of surgery in detail with the patient and informed that the tumor was at an early stage and that surgery could benefit the patient, prolong survival time and improve life treatment. The patient’s family readily agreed to give her father surgical treatment, so left hepatic lobectomy was performed, and the surgery went well with a good recovery effect.
III. Treatment results
Because of the minimally invasive surgery, the patient recovered quickly after the operation, drinking water on the 1st day, starting to eat and get out of bed on the 3rd day, and there were no obvious abnormalities in the routine blood and liver function tests, and there was no obvious bleeding and fluid accumulation in the abdominal cavity on the repeat CT. The patient was discharged on the 7th postoperative day with good healing of the incision and no infection. After discharge, the patient’s hepatitis B virus DNA quantification was lower than before, and the patient felt that his physical strength was significantly better than before, and his appetite was much better than before the surgery, and his meal quantity returned to the level before the onset of the disease, and he was in a much better state of mind. When the patient was rechecked 1 month later, an MRI was done to observe the liver recurrence, and the results showed no recurrence.
IV. Notes
The patient was successfully discharged from the hospital through active and effective treatment, and we are truly happy for her. Although the inpatient treatment came to an end, he should continue the medication after going home to avoid the recurrence of the disease. He should continue to take Sophora granules and lenvatinib mesylate capsule orally, continue the antiviral treatment with entecavir tablets orally, and review the quantification of hepatitis B DNA regularly and have abdominal imaging every 3 months to 6 months to observe whether there is any recurrence of the disease. In addition to the necessary treatment, life care is equally important. Diet, as most patients appear to lose weight during the disease period, give a high-calorie, high-protein, light, easy-to-digest diet with few and frequent meals. Fresh vegetables and fruits are consumed daily to increase appetite and to supplement micronutrients. Usually pay attention to rest and avoid long and strenuous activities. Family members should do a good job of psychological guidance to help patients to calm down and actively treat.
V. Personal insight
Hepatocellular carcinoma is mostly found in patients with hepatitis B. Therefore, if hepatitis B is detected, it is recommended to have abdominal ultrasound physical examination every six months to truly achieve early detection, early diagnosis and early treatment of hepatocellular carcinoma. Because the earlier the stage of the disease, the better the treatment effect. As in the case of the patient, if abnormalities are found and visited the hospital early, the chance of surgery exists after the doctor’s assessment, surgery is preferred and the recovery effect is good. In addition, patients with hepatocellular carcinoma should, at the same time, pay attention to the treatment of hepatitis B and systemic systemic therapy, such as targeted therapy, immunotherapy, etc.