Liver Tumor Treatment Options for Elderly Patients - Gastroenterology and Hepatology

Q: Liver Tumor Treatment Options for Elderly Patients

Hello, sir： 1. If cholangiocarcinoma has metastasized or invaded the gallbladder, the prognosis is poor. 2. Electrocautery is used for treating solitary small tumors; however, this patient is not suitable for electrocautery due to tumor invasion of the gallbla

Liver tumor treatment

Dear Director Chen,
My father is 85 years old and has been drinking alcohol since his youth, but he has never reached the level of alcoholism.
His daily routine has been normal.
In early July, he was hospitalized due to abdominal pain, and a CT scan revealed a 4 cm tumor in his liver.
He was referred to Chi Mei Hospital for treatment in mid-July, where the surgeon recommended surgical intervention.
My father does not have hepatitis B or C, and his preoperative alpha-fetoprotein level was 4.2 ng/mL.
He underwent surgery on July 16, during which the plan was to resect the right liver lobe.
However, a hard mass was discovered in segment S4B, leading to the cessation of the procedure.
The mass was sent for biopsy and was found to be malignant.
The surgeon only removed the gallbladder and cleared two lymph nodes, then closed the incision and placed an artificial blood vessel in preparation for chemotherapy.
The medical advice indicated that without chemotherapy, he has only three months left to live.
Below is a summary:
1.
Preoperative findings on July 15:
(1) Hepatitis B surface antigen quantitative: <0.05 IU/L.
(2) Hepatitis C antibody: Negative.
2.
Surgical summary on July 16 (translated by myself, unsure of accuracy):
(1) Cholangiocarcinoma of the right hepatic duct with gallbladder invasion.
(2) Suspected alcoholic liver disease with fibrosis.
(3) An infiltrative tumor approximately 6*6*5 cm in size located in segments S5-6-8, directly invading the gallbladder.
(4) Cancer cells in the intrahepatic bile ducts have invaded the hepatic veins; the liver specimen from S4B was tested and found to be malignant, leading to the cessation of surgery due to poor liver quality.
(5) Significant liver fibrosis with left lobe hypertrophy.
3.
Postoperative findings on July 17:
Alpha-fetoprotein: 4.1 ng/mL
Creatinine: 0.63 mg/dL
SGOT: 66 U/L
SGPT: 49 U/L
Total bilirubin: 1.81 mg/dL
Albumin: 2.4 g/dL
Prealbumin: 13.0 mg/dL
Hemoglobin: 14.2 g/dL
My sister and I are considering that due to our father's advanced age and frailty, chemotherapy may not be suitable for him.
We are thinking about radiofrequency ablation to treat the medium-sized tumor in the right liver.
Given the current extent of his tumor, we are unsure if he is a candidate for this procedure.
Additionally, I am troubled by the apparent contradiction between the surgical summary indicating severe liver issues and the normal blood test results.
Is it possible that if my father's liver function remains adequate, he could undergo radiofrequency ablation to extend his life, aside from chemotherapy?

Awei, 40~49 year old female. Ask Date: 2015/08/23

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir:
1.
If cholangiocarcinoma has metastasized or invaded the gallbladder, the prognosis is poor.

2.
Electrocautery is used for treating solitary small tumors; however, this patient is not suitable for electrocautery due to tumor invasion of the gallbladder and hepatic veins, as well as lymphatic involvement.

3.
Given the patient's advanced age, it may be worth discussing the possibility of palliative chemotherapy with the physician.
If it is deemed unsuitable, then hospice care can be considered to maintain quality of life.

4.
Cholangiocarcinoma may present with jaundice at a late stage and is unrelated to hepatitis B or C.

Changhua Hospital cares about your health.

Chen Shih-Tien

Reply Date: 2015/08/23

More Info

When considering treatment options for elderly patients with liver tumors, particularly in the case of your father who is 85 years old and has a complex medical history, several factors must be taken into account. The treatment landscape for liver tumors, especially in older adults, is nuanced and requires a careful balance between the potential benefits and risks of various interventions.

Understanding the Condition
Your father's case involves a 4 cm tumor that was found to be malignant after surgery was attempted. The presence of liver cancer, especially in the context of alcohol-related liver disease and possible fibrosis, complicates the situation. The fact that he does not have hepatitis B or C is a positive factor, as these viral infections are significant risk factors for liver cancer. However, the diagnosis of a malignant tumor and the subsequent findings from the surgery indicate a serious condition that requires careful management.

Treatment Options
1. Chemotherapy: The recommendation for chemotherapy is based on the aggressive nature of the tumor and the potential for it to spread. Chemotherapy can be effective in controlling the disease, but it also comes with significant side effects, especially in elderly patients who may already have compromised health. Given your father's age and current health status, the decision to proceed with chemotherapy should be made after thorough discussions with his oncologist, weighing the potential benefits against the risks of adverse effects.

2. Radiofrequency Ablation (RFA): This is a minimally invasive procedure that uses heat to destroy cancer cells. RFA can be a suitable option for patients who are not candidates for surgery due to the size or location of the tumor, or due to their overall health. In your father's case, if his liver function is relatively stable and the tumor is accessible, RFA could be considered as a palliative measure to help control the tumor and potentially extend his life. However, the extent of liver damage and the presence of other health issues must be evaluated by a specialist.

3. Palliative Care: Given your father's advanced age and the complexity of his condition, palliative care should also be a significant consideration. This approach focuses on improving quality of life and managing symptoms rather than aggressively treating the cancer. Palliative care can include pain management, nutritional support, and psychological support for both the patient and the family.

4. Monitoring and Supportive Care: Regular monitoring of liver function tests and symptoms is crucial. If your father's liver function remains stable, it may allow for more treatment options. Supportive care, including nutritional support and managing any complications from the tumor or treatment, is essential.

Addressing Concerns About Blood Test Results
It is not uncommon for patients with liver tumors to have relatively normal blood test results, especially in the early stages of liver dysfunction. Liver function tests (LFTs) can vary significantly based on the extent of liver damage and the body's compensatory mechanisms. The presence of a tumor does not always correlate with abnormal LFTs, particularly if the liver is still functioning adequately. This discrepancy can be confusing, but it highlights the importance of a comprehensive assessment that includes imaging studies and clinical evaluations.

Conclusion
In summary, your father's treatment plan should be individualized, taking into account his overall health, the characteristics of the tumor, and his personal preferences. Engaging in open discussions with his healthcare team about the risks and benefits of chemotherapy, RFA, and palliative care options is crucial. It is essential to ensure that any treatment aligns with his goals of care, particularly in maintaining quality of life during this challenging time.

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