Hepatitis B "turned negative" without re-examination, 5 years later found huge liver cancer, this case needs attention

The first time I saw Lao Cai, I was impressed by the image of a loyal and honest farmer, but I was deeply impressed by his condition.

Lao Cai is a hepatitis B virus carrier, knows that he has hepatitis B for more than ten years, and before 2017, there were irregular re-examinations of hepatitis B two-and-a-half, liver function, liver ultrasound and other tests.

However, also in 2017, Lao Cai was hospitalized for "bladder stones", and checking hepatitis B two-and-a-half before surgery suggested that hepatitis B surface antigen was negative, and when the doctor told him about this result, he asked: Does the doctor mean that my hepatitis B has no problem?

The doctor did not give him an affirmative answer, but the doctor's advice was that after discharge, he still needed to do a regular job of hepatitis B related examinations, but Lao Cai thought that he had no problem, so he did not need to do so many examinations, wasting money, so he has not been regularly reviewed since then.

However, nearly half a month before this admission, Lao Cai began to feel pain in his right upper quadrant, poor appetite, emaciation, insomnia and dreams, and did not improve after taking medicine and injections in the local clinic, so he went to the hospital for further examination and treatment.

In the outpatient department, the receiving doctor did a simple physical examination and asked the patient's medical history in detail. It was learned that he had a history of hepatitis B disease, and during the initial physical examination, it was found that the patient's face was dark, a liver disease face, very emaciated; the right upper quadrant was tender, and the liver area was percussion pain. Therefore, the focus is on liver disease.

Patients were re-examined with liver ultrasound, hepatitis B two-and-a-half, and hepatitis B virus DNA. Hepatic ultrasound suggests giant liver cancer on the right lobe of the liver, and hepatitis B is two-and-a-half (quantitative determination of hepatitis B virus surface antigen 0.83 IU/ml, quantitative determination of hepatitis B virus e antibody > 32 PEIU/ml, quantitative determination of hepatitis B virus core antibody > 60 PEIU/ml). Hepatitis B DNA assay (HBV-DNA) 362 IU/ml.

So after hospitalization, he was given an enhanced CT examination, and it was clear that there was a huge liver cancer in the right lobe of the liver, about 20x15x13CM in size, and there was a small amount of bleeding in the tumor, accompanied by cirrhosis, splenomegaly, ascites, portal hypertension, and a small amount of fluid in the chest cavity.

When I told Lao Cai about this result, Lao Cai, who had always been a little anxious, began to worry, took my hand and kept repeating the same sentence: Can the doctor cure my disease? You tell me if I'm alive for long.

I could only comfort him silently, did not say too much, although I told Lao Cai the results of the examination, but in order to follow the wishes of the family, I did not tell him all the specific conditions. Just tell him that just cooperate with the treatment.

CT of the patient

Based on all the test results, we arranged for Lao Cai to undergo hepatic artery interventional embolization chemotherapy under local anesthesia. After the operation, the puncture site was pressurized and bandaged, so that Lao Cai was absolutely bedridden, and after 24 hours, the compression bandage was removed and the bed could be moved.

Routine review on the second day after surgery: blood routine, liver function, kidney function, electrolytes, coagulation function, etc. Because lao Cai's liver cancer is huge in size and embolized in a large range of liver, liver damage, low protein, abnormal coagulation function, anemia, and edema of both lower limbs are given after surgery, and liver protection, protein supplementation, diuresis, nutritional support and so on are given.

Within three days after the operation, Lao Cai reported that he had symptoms of nausea, vomiting, bloating and pain, poor appetite, mental sleep, and fatigue. These manifestations are considered to be some mild complications that occur after the interventional embolization chemotherapy of liver cancer, and gradually improve after corresponding treatment.

One week after the operation, there are also manifestations of diarrhea, diarrhea, insomnia is a common clinical manifestation of hepatitis B, cirrhosis, liver cancer patients.

After more than ten days of treatment, Lao Cai was finally discharged from the hospital smoothly.

After one month of treatment, he was recommended to review liver magnetic resonance enhancement (disodium gadorate as a contrast agent), alpha-fetoprotein, abnormal prothrombin, enhanced CT, and blood routine, kidney function, electrolytes, myocardial enzymes, blood glucose, coagulation function, etc. that reflect the physical condition.

Re-examination of enhanced CT showed that most liver cancers had developed necrosis, but there was still a small amount of arterial blood supply, indicating that liver cancer was still active. Alpha-fetoprotein 1012.10ng/ml and abnormal prothrombin 7090.65mAU/ml, the specific indicators of liver cancer were significantly reduced compared with the previous ones. Complete blood count suggests mild anemia with hemoglobin 91 g/l. Hepatic function suggests hypoproteinemia, with an albumin 48.20 mg/L, total protein 51.90 g/L, albumin 26.40 g/L, and albumin/globulin ratio 1.04. Kidney function, electrolytes, myocardial enzymes, blood glucose, coagulation function, etc. are basically normal.

Considering the above review results, the patient's huge liver cancer has improved significantly after the first interventional treatment, and it is recommended to continue interventional therapy and combine targeted immunotherapy. At the same time, human blood albumin transfusion, nutrition and other treatments to enhance immunity.

Although Lao Cai raised more questions, he also repeatedly asked the same questions, and for such patients, doctors are more "difficult". But as the doctor in charge, I would patiently answer the questions, leave him a phone, and answer his phone from time to time to give psychological counseling.

Although Lao Cai is "difficult", he is still very cooperative with examination and treatment. Huge liver cancer, combined with severe cirrhosis, difficulty in recovery after surgical resection, according to his examination and physical conditions, developed a regimen of hepatic artery interventional embolization chemotherapy, after the first interventional treatment, a month later re-examination, if the tumor shrinks, physical condition allows, can be re-evaluated surgical resection of the conditions. When he was discharged from the hospital, Lao Cai's mental, appetite, and physical strength had recovered.

Precautions for patients in life

1, the diet is based on light nutrition, high-quality protein, avoid high oil, high sugar, high salt, fried barbecue, spicy stimulation and other foods, avoid tobacco and alcohol, stay up late.

2. Participate in social activities appropriately, be happy and maintain an optimistic attitude.

Summary: Lao Cai is a more typical mentality of the elderly in rural China, who does not understand the disease and does not pay attention to it. I have known more than ten years of history of hepatitis B disease, because after the physical examination found that "turned negative", even if the doctor said that it should be reviewed regularly, it was still because of the fear of spending money and did not have a regular physical examination. Liver cancer is generally multiplied, and the volume will double or even more in half a year, so it is emphasized that hepatitis B patients will have a physical examination once every six months, and the recommended three-month physical examination for cirrhosis of the liver is recommended. Many people are negligent, because there is discomfort to see the doctor, a test is the advanced stage of liver cancer, very painful.

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This article is original by [Dr. Luo Health Said], the author is a member of the Chinese Anti-Cancer Association, a member of the Health Communication Working Committee of the Chinese Medical Doctor Association, a health science writer, welcome to forward, comment, like, or private message with me, thank you very much!