Complications in Liver Cancer Patients: A Case Study

Q: Complications in Liver Cancer Patients: A Case Study

Hello： My grandmother has diabetes and chronic hepatitis C, and after undergoing embolization treatment for liver cancer, if the liver function of chronic hepatitis patients deteriorates, possible manifestations include the onset or worsening of jaundice, low serum albumin levels

Grandma has liver cancer and was admitted to the intensive care unit due to a urinary tract infection?

Hello! My grandmother was diagnosed with stage II liver cancer at the end of June this year (she has a history of hepatitis C, diabetes , and hypertension ).
She underwent transarterial chemoembolization at A Hospital in Chiayi.
After the treatment, she asked the doctor if she could have lumbar spine surgery to have an artificial implant (I forgot the name, but the implant itself costs over 200,000 TWD), and the doctor said it was okay.
The surgery went smoothly, but due to endocrine disorders (I remember her white blood cells, platelets, and potassium levels were all low), she stayed in the hospital for nearly a month.
After being discharged, my grandmother lived with me.
Since I have classes during the week, I provided her with adult diapers.
I suspect her urinary tract infection was due to her trying to save on diapers; she told me she was using other materials as pads, so she only needed to change those.
At that time, I didn't think much of it.
However, a few days ago (two days before she was sent to the hospital, I started noticing something unusual), I asked her in the morning if she wanted to eat, and she only said she didn't want to eat and wanted to sleep.
I gave her a can of Ensure (vanilla flavor) for lunch, and by the evening, she only ate a bite of egg.
The next morning, when I asked if she wanted to eat, she again said no, which I found strange.
I asked her to show me her phone, but she handed me the remote control, some herbal oil, and a trash bag instead, and her condition continued to deteriorate.
I then called an ambulance to take her to A Hospital's emergency department.
Upon arrival, the emergency staff informed us that "the liver cancer cells have regrown, and the situation is not good." They asked if we wanted to proceed with treatment; if not, she would be placed in palliative care.
After discussion among her children, they decided to pursue treatment, so she was transferred to the intensive care unit.
However, there were no available beds in A Hospital's ICU, so they asked if we would transfer her to B Hospital (the hospital where she had her lumbar surgery).
After the transfer, a CT scan confirmed that the cancer cells had not metastasized to the brain, but a urinary tract infection was detected, causing elevated ammonia levels, which led to her altered consciousness.
After being admitted to the ICU, the next morning we were informed that she had already gone into shock at A Hospital, her blood pressure was unstable and required pressors to maintain it, and her oxygen saturation had dropped to 65%.
The following morning, the doctor explained that "the infection and her poor liver function have led to renal failure and shock, with many levels being elevated." The doctor specifically mentioned that her bilirubin level had reached 14.X, stating that typically, levels above 15 are very concerning.
(However, I read online that some people with high bilirubin levels undergo liver transplants to maintain levels around 15; why is that? Some even have higher levels.
Today at the hospital, I asked a nurse if 15 applies to my grandmother, and he said some can reach 20, so I really don’t understand.) On the third day, the doctor said her condition was more stable, the pressors were no longer needed, and her oxygen levels were decreasing.
We would have to wait for Monday's report to know more.
Today, my grandmother's eyes are still very yellow, but her face has returned to normal.
Thank you for taking the time to read my lengthy question; I apologize for the length.
I really didn't know how to ask questions to the doctors at B Hospital, which is why I came here to ask.
Thank you, doctor.

Mr. Zeng, 10~19 year old female. Ask Date: 2013/10/20

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: My grandmother has diabetes and chronic hepatitis C, and after undergoing embolization treatment for liver cancer, if the liver function of chronic hepatitis patients deteriorates, possible manifestations include the onset or worsening of jaundice, low serum albumin levels, abdominal distension due to ascites, elevated blood ammonia levels, and signs of hepatic encephalopathy.
Patients with chronic hepatitis and cirrhosis may experience worsening liver function due to infections, gastrointestinal bleeding, or the progression or metastasis of liver cancer, leading to the aforementioned symptoms—jaundice, exacerbated ascites with infection, hepatic encephalopathy, impaired coagulation function, hepatorenal syndrome, and renal failure, as well as hepatopulmonary syndrome and respiratory failure.
With proper infection control and management in the intensive care unit, it is essential to monitor whether liver function can gradually improve, as elevated jaundice indicates poor liver function.
Wishing you health, Dr.
Lin Ming-Hui, Taoyuan Hospital.

Reply Date: 2013/10/20

More Info

Liver cancer, particularly in patients with underlying conditions such as hepatitis C, diabetes, and hypertension, presents a complex clinical picture that requires careful management and monitoring. Your grandmother's case illustrates the multifaceted challenges that arise when treating liver cancer, especially when compounded by other health issues.

Firstly, it is essential to understand that liver cancer is often diagnosed at advanced stages due to the lack of early symptoms. In your grandmother's case, being diagnosed with stage II liver cancer indicates that the cancer has progressed but may still be treatable. The treatment she received, transarterial chemoembolization (TACE), is a common approach for managing liver tumors, especially in patients who are not candidates for surgical resection. This method aims to cut off the blood supply to the tumor, thereby inhibiting its growth.

After the TACE procedure, your grandmother experienced complications, including endocrine imbalances that led to low white blood cell counts, low platelet counts, and low potassium levels. These complications can arise from both the cancer itself and the treatments administered. The prolonged hospital stay following her surgery indicates that her body was struggling to recover, which is not uncommon in patients with liver dysfunction.

The urinary tract infection (UTI) that developed is another significant concern. UTIs can occur in patients who are less mobile or who have undergone recent surgeries, particularly if they are using urinary catheters or pads, as in your grandmother's case. The infection likely contributed to her altered mental status, which was exacerbated by elevated ammonia levels—a condition known as hepatic encephalopathy. This occurs when the liver fails to adequately filter toxins from the blood, leading to neurological symptoms.

Regarding the jaundice and elevated bilirubin levels, it is crucial to note that bilirubin levels can vary significantly among patients. While a bilirubin level above 15 mg/dL is concerning and often indicates severe liver dysfunction, some patients can tolerate higher levels without immediate life-threatening consequences. The decision to consider liver transplantation in patients with high bilirubin levels depends on various factors, including the overall health of the liver, the presence of other complications, and the patient's prognosis.

In your grandmother's situation, the medical team is likely monitoring her closely to assess her liver function and response to treatment. The fact that her condition stabilized after being transferred to the ICU is a positive sign, but ongoing vigilance is necessary. The medical team will evaluate her lab results and overall clinical picture to determine the best course of action moving forward.

It is understandable to feel overwhelmed and uncertain during such a challenging time. When speaking with the medical team, consider asking specific questions such as:
1. What are the current treatment options available for my grandmother's liver cancer?
2. How can we manage her urinary tract infection and prevent future infections?
3. What steps can be taken to improve her liver function and overall health?
4. What are the potential outcomes based on her current condition?
Open communication with healthcare providers is vital, as they can provide tailored information and support based on your grandmother's unique situation. Remember, you are not alone in this journey, and seeking clarity from the medical team is an essential part of advocating for your grandmother's health.

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