We received my husbands reports in the mail so I thought I'd share the with you.
Labs...WBC 5.83, HGB13.7, Platelets 74, INR1.2, Total Bili 2.9, ALK Phos 205, AST 99, ALT 43, Alb 3.5, AFP 1940.0
IR Examination...Mildly juandiced, 2+ pitting endema to ankles bilaterally, no clubbing or cyanosis, 2+ pedal pulses bilaterally.
Imaging... MRI of the abdomen demonstrats multifocal patchy enhancement likely consistent with multifocal HCC. There is enhancement adjacent to the ablation defect suspicious for tumor recurrence.
Impression and plan... This patient is a very pleasent 56 year old male with a history of hep-c, cirrhosis, hepatocellular carcinoma who is status post RFA and TACE. The MRI demonstrates multifocal recurrence, with multiple small nodules of suspected tumor within the liver. He discussed with us these finding in great detail. Due to patients current liver function he is NOT a candidate for further locoregional treatment at this time. The option of Nexavar was discussed and will discuss with Oncologist. IF liver function improves, we can readdress the possibly of futher locoregional treatment, which could include raduoembolization given the poor response to TACE and RFA.
The MRI Findings... The segment 5 ablation defect is similar to the prior study excet that there are patchy areas of arterial phase enhancement at its posterior superior aspect the 1.8 cm segment V/VI lesion previously measuring 1.8 cm now measures 1.4 cm but does not have clearly have washout or delayed pseudocapsule. However, one additional area which are hypervascular have portal venous washout and suggestion of pseudocapsule including segment VI/VII measuring 1.9 cm and segment II measuring 1.7 cm and 0.6 cm on the same image. Two foci with suggestion of peripheral arterial enhancement in the caudate lobe measure maximally 1.7 cm and are slightly larger but do not have definite pseudocapsule on delayed imaging.
The liver remain cirrhotic in morphology. The portal vein is patent. An accessory left hepatic artery appears to arise from the left gastric. Spleen remains enlarged. No gastroesophageal mucosal varices are clearly suggested but artifact may limit sensitivity. Trace fluids surrounds the liver. Gallbladder wall is thickened without calculi. A puncate fluid signal intensity focus in the pancreatic uncinate process consistant with IPMN is stable.
1. Small Amount of periablation suspicious arterial enhancement
2. Additional liver lesions are more conspicuous and are classified as classified as OPTN 5a or OPTN 4g.
3. Cirrhosis with portal hypertension. Gallbladder wall thickening may reflect diffuse lever disease.
He sees his Oncologist on Wednesday to see if he is a candidate for that medication.
Needless to say my heart is breaking. I hate waiting, Wednesday is a long ways away. I don't know if they can shrink these tumors if not the combined measurement is beyond 5cm.
I'll update you all on Wednesday thank you for being here.