Hepatocellular Carcinoma BCLC A
related Hepatitis C
Clinical Details
• Female, 56 years old
• Mass in the right upper quadrant abdomen, loss of
appetite, decrease of body weight
• Without sign and symptom cirrhosis hepatic, PS 0
• DAA is still waiting (4 months)
• Resection procedure is still waiting too (6 months) • Fibroscan 5.8 kPA
Clinical Findings/Investigations
• Hb 14.6 g/dL, WBC 7.870 x 103/uL, Platelet 192.000 x 103/uL, ESR
34 mm/h, AFP 34.687.9 ng/mL, albumin 3.7 g/dL, globulin 4.9
g/dL, AST 75 U/L, ALT 77 U/L, direct/total bilirubin 0.6/ 1.41
mg/dL, PPT 12”, aPTT 29.2”, HbsAg Non reactive, Anti HCV
Reactive, HCV RNA 1.07 x 106 IU/mL (Log 6.03)
• USG abdominal : solid heterogen mass in 7th
segmen size 5.6 x 5.3 cm, normal portal flow
• CT abdominal without and with contrast :
enlargement of liver, increase parenchymal
density, without widening IHBD/EHBD,
normal vena hepatica and vena porta,
hipodense lesion, clear line, size 5.47 x 5.54
cm in right lobe, with wash-in wash-out
phenomenon
Clinical Problems/Questions?
• What should we do if DAA still waiting for
• What can we do while resection procedure is still waiting for
• How to management for perioperative procedure in this case
• Are they any alternative for management this patient
• How should we do after resection? Are they adjuvant therapy
for prolong life expectancy and improve quality of life without
cancer recurrence?