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Dr. Andrew Rynne
Dr. Andrew Rynne

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Looking for a hapatologist for later stage liver cancer. What is the best medication?

Answered by
Dr. Indranil Ghosh


Practicing since :2004

Answered : 1506 Questions

Posted on Tue, 16 Oct 2012 in Cancer
Question: Looking for a hapatologist or someone who is familiar with later stage liver cancer. I have a company in India and one of my employees recently had his father diagnosed with late stage liver cancer. Quite frankly, I have had a couple of misdiagnosis cost the lives of my employees families before and am finding it increasingly difficult to trust medical help in that area of the world. The blood work doesn't match up and either do his symptoms. His is not jaundiced, RBC count is normal, glucose levels are pretty normal, spleen is slightly englarged (not much), kidney functions, appendix functions, etc. check out......... His father also has HBV and was placed on some pretty harsh medication to treat that about 4 weeks ago and does have what they are calling a level 1 fatty liver. Not coincidentally, in my opinion, the man started to have lots of serious symptoms that would seem to indicate a serious reaction to the HBV medication. Something doesn't add up here and to make matters worse they are not even treating his most dire symptoms. The man has not even been hospitalized yet! He has lost 16kg of weight in the past 15 days and has serious diarrhea problems. He has to be completely dehydrated and feeling weak and needs IV fluids something awful. Very frustrating to say the least. So, getting to my point, is a doctor able to look at blood work and determine within a reasonable level of accuracy that a man has late stage liver cancer? To me, his blood work looks near to normal. Maybe a little on low normal or high normal sides, but NORMAL. Also, if someone has diarrhea what is the best medication to treat it? Cipro? Immodium A D? Anything stronger out there? This man will pass away from dehydration very soon if he has no fluids in his body and has no way to hold down any fluids.
Answered by Dr. Indranil Ghosh 10 hours later

Thanks for writing in.

The patient has chronic hepatitis B and cirrhosis for sure. The CT scan abdomen also suggests metastatic liver cancer which is quite frequent in cirrhotic liver. Unfortunately I don't see any biochem reports in the attachments. In particular I need the liver function and AFP reports. If AFP is significantly high then it substantiates the diagnosis of hepatocellular cancer.

As for entecavir, it is the drug of choice for the hepatitis at this time, though it won't lead to the resolution of cirrhosis or liver cancer. If he has liver cancer then the best bet would be sorafenib, an oral drug which can control it for a few months.

The diarrhea needs evaluation-whether its an infection, or drug-induced or something else. IV fluids are needed if he can't maintain hydration.

He can consult Dr XXXXXX Bondarde at Shatabdi Hospital, Nasik (medical oncologist) who can take good care of him.

Hope I have answered your query. I will be available for further follow-up queries, if any.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Indranil Ghosh 55 minutes later

Thank you for your thoughtful reply.

I was also looking for the AFP reports, but they are being conducted in Mumbai at the moment. I should have that information available in a couple of days. Most likely after the weekend. I also greatly appreciate your professional reference to a Doctor in Nasik as this is where my company is located.

You have restored some of my belief in the medicine system of India. I thank you for that...... We have had a bad run on a personal level in Nashik with misdiagnosis of problems and lack of proper treatment. I won't elaborate at this time, but we have certainly experienced some sorrow in our TopRock family and it has not been easy. My guess is that we will have to experience some more sadness, but I have resolved myself to at least try to help when I am able. Sending vitamins or simply asking for a second medical opinion. Albeit through a virtual world.

I will speak with my managing director in about one hour and make sure he has this information so that he may provide this to our employee. I am sure XXXXXX will be greatly appreciative of your thoughts and time.
Answered by Dr. Indranil Ghosh 1 hour later
Thanks for your nice words.
Please send me the AFP when its available.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Indranil Ghosh 4 days later
Dr. Indranil,

I have attached 3 additional scans provided to me by our employee. If you could please review this information, it would be greatly appreciated.


Answered by Dr. Indranil Ghosh 9 hours later
I am not seeing any new scan. I am still seeing the old case papers (upto No 9).
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Indranil Ghosh 12 hours later
I am not able to attach the Scan copies here. The system is broken somehow. I was initially able to upload things, but cannot add new items it seems. I even tried removing some items........... The main result is that this man has a count of 3,34,000 for AFP which is WAY over the normal rate in the low to middle 100s.

Based on such a high reading with AFP, you would conclude he is very likely to have liver cancer and needs treatment immediately?

For some reason, my employee is hesistant to take his father in to see an oncologist. I told him, if your father has cancer he needs to see someone who specializes in cancer treatments. He is worried about Chemotherapy. Are there other alternate treatments that can be recommended to him? The family is really not wanting him to go through that kind of treatment path and has been seeking advice from gastrointestinal doctors for second opinions and options on treatment. Logically, I think it is best to see a cancer specialist if you have cancer, but convincing him of that is not an easy task at the moment. He is not realizing that different doctors who specialize in cancer can offer different treatment options. Although I honestly know very little about liver cancer treatment options.
Answered by Dr. Indranil Ghosh 24 minutes later
Yes, this is liver cancer.

As I had mentioned in my first reply that that the best bet is sorafenib which is some sort of targeted therapy and much less toxic than chemo. It should however, be taken only under the supervision of a medical oncologist.

The life expectancy remains low (6-9 months).
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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