How Can We Treat a Patient With Liver Cirrhosis (Hepatitis C Virus), Hepatocellular Carcinoma, and Synchronous Colon Cancer?
| Autor: | A. Labadariou, A. Smyrnis, Alkiviadis Kostakis, N. Nikitakis, N. Tsavaris, P. Paraskeva, Dimitrios Mantas, Dimitrios Dimitroulis, Efstathios Antoniou, P. Vernicos |
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| Rok vydání: | 2012 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Carcinoma Hepatocellular Time Factors Cirrhosis Organoplatinum Compounds Colorectal cancer Biopsy medicine.medical_treatment Leucovorin Milan criteria Gastroenterology Neoplasms Multiple Primary Fatal Outcome FOLFOX Sepsis Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Colectomy Incidental Findings Transplantation business.industry Liver Neoplasms Sigmoid colon Colonoscopy Bowel resection Hepatitis C Chronic Middle Aged medicine.disease digestive system diseases Liver Transplantation Surgery Treatment Outcome medicine.anatomical_structure Chemotherapy Adjuvant Hepatocellular carcinoma Colonic Neoplasms Fluorouracil Neoplasm Recurrence Local Multiple Myeloma business medicine.drug |
| Zdroj: | Transplantation Proceedings. 44:2745-2747 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2012.09.003 |
| Popis: | Introduction The coexistence of liver cirrhosis with hepatocellular carcinoma (HCC) and colon cancer (Ca), which is a rare clinical condition, was treated in a liver transplant recipient. Patients and methods A 46-year-old man, diagnosed incidentally during an ultrasound (US) examination with a 3.5-cm HCC in segment VII related to chronic hepatitis C virus (HCV), was referred for liver resection. He underwent a laparoscopic protocol evaluation for liver cirrhosis. Liver appearance and biopsy of the left lobe showed Child B/C liver cirrhosis. Because he fulfilled the Milan criteria, we suggested an orthotopic liver transplantation (OLT). During protocol colonoscopy, we discovered an ulcerative sigmoid colon Ca. Three weeks after completing the pre-OLT assessment he underwent an OLT and was discharged home on day 9 on an immunosuppressive regimen of Everolimus, Myfortic, and Prezolone. Two months after transplantation, the patient underwent a sigmoidectomy and for nearly 1 month thereafter received chemotherapy for colon Ca (6 cycles of FOLFOX:Folinic Acid+Fluorouracil+Oxaliplatin). One and a half years after OLT, patient was in good condition but presented with an increased alpha fetoprotein (a-FP) without other findings. A couple of months later we discovered a colon Ca recurrence and 3 small liver metastases. Patient underwent a bowel resection with Hartmann's procedure. Almost immediately after the last operation, he was found to suffer multiple myeloma. He underwent chemotherapy for both malignancies with good responses, but a few months later died of severe sepsis. Discussion The relevant literature regarding treatment of liver cirrhosis complicated with HCC and synchronous colon Ca reveals poor and controversial outcomes. Our patient underwent chemotherapy immediately after colon resection in the presence of with a good functioning liver. Although his condition was satisfactory after OLT, the optimal treatment of such complicated patients is as yet uncertain. |
| Databáze: | OpenAIRE |
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