Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of known Hepatocellular Carcinoma (HCC) with evidence of macroscopic vascular invasion involving the portal vein (PVT). Patient reports [symptom status: e.g., abdominal pain, early satiety, weight loss, or asymptomatic]. Review of systems positive for [e.g., jaundice, ascites, hematemesis]. Current ECOG performance status is [0-4]. History of underlying liver disease: [e.g., HBV, HCV, NASH, Alcohol-related cirrhosis]. Child-Pugh score: [A/B/C].
Clinical Examination Findings
General: Patient appears [well/ill-appearing], jaundiced, cachectic. Abdomen: Distended, positive shifting dullness (ascites), hepatomegaly, splenomegaly, tenderness to palpation in RUQ. Vascular: No audible bruits. Extremities: Bilateral pitting edema, palmar erythema, spider angiomata present. Neurological: Alert and oriented, no evidence of asterixis or hepatic encephalopathy.
Treatment Protocol
Treatment plan: Multidisciplinary tumor board review completed. Given macroscopic PVT, patient is classified as BCLC Stage C. Recommended therapy: [e.g., Systemic therapy with Atezolizumab/Bevacizumab or Durvalumab/Tremelimumab]. Monitor for treatment-related toxicities, liver function tests, and serial imaging (CT/MRI) every 8-12 weeks. Consider palliative care consultation for symptom management.