Detailed Treatment Process
Female, 50 years old Last year she underwent surgical treatment for primary hepatocellular carcinoma In the outpatient record dated December 10 last year, the doctor had already noted small nodules in both lower lungs and recommended transfer to interventional therapy or consideration of targeted drug treatment. At that time, targeted drugs could easily cost hundreds of thousands of yuan. This January’s examination revealed a new lesion at the top of the liver, multiple round-like low-density shadows within the liver, blurred edges of the lesion near the top of the liver, and obvious early enhancement after contrast administration. This indicated recurrence only a few months after surgery. The lung imaging on January 5 also showed small nodules in both lower lungs, raising the possibility of pulmonary metastasis. The abdominal CT plain scan plus enhanced scan on May 7 showed: newly appeared multiple metastatic lesions in the abdominal 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 metastasis. The patient’s routine blood test showed granulocytopenia, considered related to the oral anticancer medication she was taking. Liver function tests were normal, which served as the main basis for maintaining the patient’s confidence at present. The patient believed that as long as liver function was normal, there was no problem. Because she had a more than twenty-year history of chronic hepatitis B, with long-term abnormal liver function that had never fully normalized, and it was precisely this long-term chronic hepatitis B that had led to the development of hepatocellular carcinoma. The alpha-fetoprotein test value on May 7 was significantly elevated, which in fact clearly indicated tumor recurrence and serious progression. The patient’s own handwritten record of alpha-fetoprotein values showed: the highest value on January 22 last year, a rapid decline after surgery (estimated around February), then a rise again starting from September last year, suggesting recurrence; further elevation by this January, reaching 1039 on May 6. The author visited the patient’s home this year, at which time she was taking oral anticancer medication. The patient’s external appearance was basically normal. Her walking gait, movements, and facial expressions showed no obvious abnormalities. Her body shape was also normal in terms of weight. Both static and dynamic observation revealed no detectable abnormalities, and she did not look like a patient with advanced cancer at all. The only obvious abnormality was a rather poor complexion, with dark and dull skin tone, resembling the look of someone who had not rested for a long time, but to a more pronounced degree. Twelve months after this time point, the patient died.