Detailed Treatment Process
2 min read
Female, 50 years old. Last year she underwent surgery for primary liver cancer. In the outpatient record dated December 10 last year, the doctor had already noted small nodules in both lower lungs and recommended referral for interventional therapy or consideration of targeted drug treatment. At that time, targeted medications could easily cost hundreds of thousands of dollars. Imaging in January this year revealed a new lesion at the top of the liver, along with multiple rounded low-density shadows within the liver. The lesion near the top of the liver had blurred margins and showed marked early enhancement after contrast administration. These findings indicated recurrence just a few months after surgery. Pulmonary imaging on January 5 also showed small nodules in both lower lungs, raising the possibility of pulmonary metastases. Abdominal CT with plain and contrast-enhanced scans on May 7 showed multiple new metastatic lesions in the peritoneal cavity, local thickening of the peritoneum in the left upper abdomen, small retroperitoneal lymph nodes, and multiple nodules in both lower lungs, all highly suspicious for metastases. The patient's blood count showed granulocytopenia, considered related to the oral anticancer medication she was taking. Liver function tests were normal, which was the main factor sustaining the patient's confidence at the time. She believed that as long as her liver function remained normal, there was nothing to worry about. She had a more than 20-year history of chronic hepatitis B, during which her liver function had been abnormal for years and never fully normalized. It was this long-standing chronic hepatitis B that had led to the development of her liver cancer. Alpha-fetoprotein levels measured on May 7 were significantly elevated, clearly indicating tumor recurrence and serious progression. The patient's own handwritten records of her alpha-fetoprotein values showed the highest level on January 22 last year, a rapid decline after surgery (around February), followed by a rise beginning in September last year that suggested recurrence. Levels continued to climb, reaching 1039 by May 6 this year. The author visited the patient at her home this year while she was taking oral anticancer medication. Her external appearance was essentially normal. Her gait, movements, and facial expressions showed no obvious abnormalities. Her body weight was normal, and neither static nor dynamic observation revealed any issues. She did not look like a patient with advanced cancer. The only notable abnormality was her poor complexion, with a dark and dull skin tone resembling someone who had not rested well for a long time, though more pronounced. Twelve months after this visit, the patient died.