j****d
发帖数: 123 | 1 sorafenib 失效, 肺转伴有症状,精神不佳. 目前还能travel, 寻求更有效或更新疗法,
包阔药试 - China, HK, 台湾, US. 谢谢关爱.
详情
Pathology report (by pathologist from Fudan University affiliated Sun Yat-
sen Hospital) 复旦大学附属中山医院病理报告
female, primary HCC diagnosed Nov 2011
女, 65 岁, 55 KG (58 KG presurgery). 原发性肝细胞肝癌
1) greyish white liver mass, 7.5x6 cm, adjacent to capsular, with 10+
satelite lesions, ranging 0.2 - 0.8 cm in diameter.
肝肿块 7.5x6 cm, 紧贴肝被膜,子灶10余个,大小不等, 周围肝土黄色, 细腻
2) also seen greyish white mass 5x5x4 cm with membrane, section face grey to
brown in color, partially hemorragic. Alongside gastric tissue measuring
4x2x1 cm
另见灰白带包膜肿物一个, 5x5x4 cm, 切面灰褐, 部分出血, 旁附少许胃组织, 大小
4x2x1 cm
Diagnosis: right-side hepatocellular carcinoma, grade II - III with 2ndary
lesions, sorrounding hepatic tissue G1S0; spleen and stomach interstitial
stromal tumor,
诊断: 右边原发性肝细胞肝癌 II 到 III 级, 伴子灶, 周围肝G1S0; 胃/脾间质瘤, 细
胞丰富, 轻度异型, 核分裂相难见.
Treatment history
治疗史
Nov 18, 2011 - surgery. Section VI, VII, VIII and partial diaphram resected
, stomach partly removed due to GIST 肝六,七,八区切除,部分纵隔,部分胃切除
Nov 18, 2011 - TACE: EADM (表阿霉素) and Lipiodol (碘油)
Feb 7, 2012 - TACE. Mets to both lungs 双肺多点转移. Starting sorafenib,
800mg + 800mg per day
Jun 15, 2012 - TACE. Stopped sorafenib
Aur 9, 2012 - TACE + BAI
Aug 16, 2013 - resuming sorafenib 800 mg + 400 mg per day
Laboratory
AFP 60,500
CEA 2.17
CA19-9 9.4
AST 66
AP 84
GGT 174
Bile acid 52.0 | l*h
发帖数: 4124 | 2 I don't question the diagnosis of HCC, but the pathology report is of very
low quality, and I don't understand the treatment strategy either.
1. there is no description of microscopic findings, there is no way to tell
if the histological grading is correct or wrong. it seems almost all
pathologists in China have the magic power to give an unequivocal diagnosis
on everything.
2. stomach stromal tumor is rare, spleen stromal tumor is extremely rare. i
simply cannot believe all three tumors occur at the same time. I don't
believe you can make such diagnosis without a thorough description of
findings and differential. did the "oncologist" ever discuss the diagnosis
with the pathologist, or just accepting anything and everything others say?
3. why was transarterial chemo embolism used as the primary treatment for
HCC when you have multiple (regional or remote) metastasis?
4. why was sorafinib prescribed? just by trusting the stomach and spleen
stromal tumor diagnosis?
法,
【在 j****d 的大作中提到】
: sorafenib 失效, 肺转伴有症状,精神不佳. 目前还能travel, 寻求更有效或更新疗法,
: 包阔药试 - China, HK, 台湾, US. 谢谢关爱.
: 详情
: Pathology report (by pathologist from Fudan University affiliated Sun Yat-
: sen Hospital) 复旦大学附属中山医院病理报告
: female, primary HCC diagnosed Nov 2011
: 女, 65 岁, 55 KG (58 KG presurgery). 原发性肝细胞肝癌
: 1) greyish white liver mass, 7.5x6 cm, adjacent to capsular, with 10+
: satelite lesions, ranging 0.2 - 0.8 cm in diameter.
: 肝肿块 7.5x6 cm, 紧贴肝被膜,子灶10余个,大小不等, 周围肝土黄色, 细腻
| j****d
发帖数: 123 | 3 I did the translation, but do not know the patient. I think it is better to
say: primary HCC with suspected GIST. I agree pathologists in China are
mostly grossly unqualified. But you have to know, that is just what chinese
patients and family need - they fear cancer so much that they don't want to
know more. Most cancer patients in China are protected from knowing the
truth of their disease, by family and also by clinicians. Social problem.
A billion people with no faith of any kind, go figure.
TACE is local but sorafenib is systemic and both are approved therapies for
HCC. They worked for her but simply have run out of effectiveness. Could
be acquired resistance, but no approved therapy has been real long-term
success in HCC according to what I read. That's why they want open-minded
advices. Therefore, if you can suggest something positive - theoretical or
practical, please do so and regardless of outcome, your effort will be
highly valued. | l*h
发帖数: 4124 | 4 i knew both TACE and sorafenib were approved for HCC. however i question the
indications upon which they were used.
why was TACE used as a primary treatment when multi-site metastasis already
occurred and local sites and regional metastasis were resected?
i don't think anyone has shown sorafenib is effective when remote metastasis
is obvious.
i truly don't think it's ethical to use every patient as a lab rat. in
addition, there is no proper study design, there will be no improvement for
future therapy.
to
chinese
to
for
【在 j****d 的大作中提到】
: I did the translation, but do not know the patient. I think it is better to
: say: primary HCC with suspected GIST. I agree pathologists in China are
: mostly grossly unqualified. But you have to know, that is just what chinese
: patients and family need - they fear cancer so much that they don't want to
: know more. Most cancer patients in China are protected from knowing the
: truth of their disease, by family and also by clinicians. Social problem.
: A billion people with no faith of any kind, go figure.
: TACE is local but sorafenib is systemic and both are approved therapies for
: HCC. They worked for her but simply have run out of effectiveness. Could
: be acquired resistance, but no approved therapy has been real long-term
| j****d
发帖数: 123 | 5 so, mind me asking: Dr LMH, what DO you prescribe for your HCC patients with
distant metastasis? | l*h
发帖数: 4124 | 6 1. i would have been completely honest with the pt from the beginning, to
explain the options at hand. quite few patients pursue painful treatment
without known benefits.
2. i would have ordered FDG-PET before surgery to look for metastasis.
regional met should be easily seen on CT or ultrasound before surgery. when
there is regional metastasis, there is almost certain also remote metastasis
. there is just some time lag. you cannot assume there is no. i truly don't
trust the so-called "spleen stromal tumor." it could simply be a met.
3. sorafenib, if to be used, should have been used from the beginning, if
she has those mutations. not when you have seen lung metastasis. it's simply
too late. at that time, it does NOT improve quality of life, may rather
cause interstitial damage to lungs and hearts.
4. surprisingly, many conventional palliative regimens reduce the number of
remote metastasis, and improves quality of life, even though no improvement
in survival.
5. focused radiation therapy, if the metastasis is not diffuse, is often
very effective to control metastatic lesions and improve quality of life,
even though no significant improvement in survival.
Dr. Tang should feel very disappointed if he should see what his hospital
looks like now.
with
【在 j****d 的大作中提到】
: so, mind me asking: Dr LMH, what DO you prescribe for your HCC patients with
: distant metastasis?
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