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What Is The Life Expectancy Of Someone With Hepatocellular Carcinoma?
Question: 65yoF dx with cirrhosis--has hx of portal HTN on Propanolol, has had varices banded, pleural effusion on Coumadin, on Lasix and Aldactone for edema, Lexapro for depression and Xifaxan for HE and has been on it for months. Still has episodes of breakthrough HE symptoms. Went without Xifaxan 3 days last week and became very shaky. Has pruritis episodes, palmar erythema, muscle wasting. Platelets at 30,000. Bilirubin--2.9 and Albumin 3.1. Also has episodes of hypoglycemia corrected with eating. Pt. is an RN so takes care of most problems on her own at home. Having more difficulties with taking care of her own finances, movements are very slow and deliberate. Has episodes of nausea with vomiting but no vomiting blood since varices banded 1 1/2 yrs ago. What would be an estimate of life expectancy?
Brief Answer:
It is highly varied depending on various factors...
Detailed Answer:
I warmly welcome you here at HCM. I can well establish the sensitivity of health issue you raised. After careful review of the query and related details I want to add here that patients with cirrhosis have a widely variable course of disease and varied prognosis therefore.
Prognosis depends on physiologic functions of liver where it forms different products for the body to run normally; the effective therapeutic measures to slow down or stop the processes deteriorating the condition, occurrence of hepatocellular carcinomas. Life Expectancy varies patient to patient.
This depends mainly on Compensated cirrhosis and in some it can lead to decompensated cirrhosis that deteriorates fast and life expectancy is decreased so much.
Compensated cirrhosis has:
Stage 1:- No varices and No ascites
Stage 2:- Varices(present), Ascites not present.
Your case falls in stage 2 of compensated cirrhosis. It has little better prognosis than Uncompensated cirrhosis but obviously it has poor prognosis as compared to stage 1 of compensated cirrhosis patients.
It is all relative to say how many years. The medications seem to be OK. But liver seems to be damaged much up till now. Avoidance of alcohol and before taking any medications medical consultation on dosage is importantly needed.
Hope it helps you today.
Please feel free to contact me anytime directly from my profile: tinyurl.com/drhanifmd if you need further assistance.
If satisfied here, click on Close the Discussion and give your valuable feedback too.
Regards!
It is highly varied depending on various factors...
Detailed Answer:
I warmly welcome you here at HCM. I can well establish the sensitivity of health issue you raised. After careful review of the query and related details I want to add here that patients with cirrhosis have a widely variable course of disease and varied prognosis therefore.
Prognosis depends on physiologic functions of liver where it forms different products for the body to run normally; the effective therapeutic measures to slow down or stop the processes deteriorating the condition, occurrence of hepatocellular carcinomas. Life Expectancy varies patient to patient.
This depends mainly on Compensated cirrhosis and in some it can lead to decompensated cirrhosis that deteriorates fast and life expectancy is decreased so much.
Compensated cirrhosis has:
Stage 1:- No varices and No ascites
Stage 2:- Varices(present), Ascites not present.
Your case falls in stage 2 of compensated cirrhosis. It has little better prognosis than Uncompensated cirrhosis but obviously it has poor prognosis as compared to stage 1 of compensated cirrhosis patients.
It is all relative to say how many years. The medications seem to be OK. But liver seems to be damaged much up till now. Avoidance of alcohol and before taking any medications medical consultation on dosage is importantly needed.
Hope it helps you today.
Please feel free to contact me anytime directly from my profile: tinyurl.com/drhanifmd if you need further assistance.
If satisfied here, click on Close the Discussion and give your valuable feedback too.
Regards!
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your response--I forgot to mention that she is sleeping 16-18 hours daily and is extremely slow in her movements and thought process. This I assume is from the HE, for which she is being treated but seems to have continual issues ongoing with it. I also forgot to mention she also takes Prilosec, Ultram 50mg, Q4H PRN pain, Levsin and a pill for nausea PRN. She has also been on Levaquin twice since January for UTI and took a round of Prednisone for pruritis in March.
Brief Answer:
Hepatic encephalopathy is main reason for her somnolence & slow reflexes!!!
Detailed Answer:
She is having symptoms of kidney damages too and in cirrhotic patients the development of renal failure ( Hepatorenal syndrome ) is almost inevitable and patients develop the renal failure complications in the natural course of disease down the road.
Yes, she is having this somewhat altered sensorium and excess sleepiness due to HE and is due to loss of normal brain functions, caused by the accumulation of excess nitrogenous waste products in blood (because natural degradation processes of liver are no more there to excrete the metabolic wastes of body).
Her MELD Score falls somewhat on lower sides (range is 6 to 40) and I don't agree the liver transplant as an option at this stage of her disease.
But one thing is sure that symptoms and condition suggest, there is massive liver damage and the prognosis is somewhat not so bad until late after the evolution of complications including but not limited to Ascites and edema, bacterial infection of the abdominal cavity, full blown HE, severe Hepatorenal syndrome (kidneys are failing), diabetes mellitus, Hepatopulmonary syndrome (lungs affected), blood counts change, bruises and bleeds under the skin, easy infections anywhere in body (she already had UTI twice as you stated in follow up query), lowered immunity and lack of energy, loss of muscles mass, spleen issues and cancer of the liver and ultimately can be fatal.
This concludes her present condition that you are concerned about and the outcome of natural process of disease despite doing the heroic measures to make her disease status better.
Hope it helps you today.
If you need further assistance, please feel free to contact me anytime directly from my profile: tinyurl.com/drhanifmd .
If satisfied here, please click on Close the Discussion and give your valuable feedback too.
Regards!
Hepatic encephalopathy is main reason for her somnolence & slow reflexes!!!
Detailed Answer:
She is having symptoms of kidney damages too and in cirrhotic patients the development of renal failure ( Hepatorenal syndrome ) is almost inevitable and patients develop the renal failure complications in the natural course of disease down the road.
Yes, she is having this somewhat altered sensorium and excess sleepiness due to HE and is due to loss of normal brain functions, caused by the accumulation of excess nitrogenous waste products in blood (because natural degradation processes of liver are no more there to excrete the metabolic wastes of body).
Her MELD Score falls somewhat on lower sides (range is 6 to 40) and I don't agree the liver transplant as an option at this stage of her disease.
But one thing is sure that symptoms and condition suggest, there is massive liver damage and the prognosis is somewhat not so bad until late after the evolution of complications including but not limited to Ascites and edema, bacterial infection of the abdominal cavity, full blown HE, severe Hepatorenal syndrome (kidneys are failing), diabetes mellitus, Hepatopulmonary syndrome (lungs affected), blood counts change, bruises and bleeds under the skin, easy infections anywhere in body (she already had UTI twice as you stated in follow up query), lowered immunity and lack of energy, loss of muscles mass, spleen issues and cancer of the liver and ultimately can be fatal.
This concludes her present condition that you are concerned about and the outcome of natural process of disease despite doing the heroic measures to make her disease status better.
Hope it helps you today.
If you need further assistance, please feel free to contact me anytime directly from my profile: tinyurl.com/drhanifmd .
If satisfied here, please click on Close the Discussion and give your valuable feedback too.
Regards!
Above answer was peer-reviewed by :
Dr. Deepak
Thank you so much for your responses. I really appreciate your time and feedback. In addition, I can add that she does bleed easily but is careful not to cut herself. She does complain of nausea and vomiting regularly, she does have significant swelling to both her lower extremities all the time with the right leg swelling worse than the left. There is muscle wasting, weight loss, neuropathy, decreased appetite and constant fatigue. She also on U/S last week showed enlarged spleen and I assume the platelet count of 30,000 is because of the spleen being affected.
I'm sorry to keep sending things back to you but with each note you have sent, I have encountered more information that you probably need. Again, I really appreciate the time you've taken to respond to my questions. As an RN, she seems to want to take care of things on her own and not let her family know what is going on with her and they are getting extremely frustrated with the lack of information. Your information has been very informative and is right in line with what I had come up with in my research. Thank you very much.
I'm sorry to keep sending things back to you but with each note you have sent, I have encountered more information that you probably need. Again, I really appreciate the time you've taken to respond to my questions. As an RN, she seems to want to take care of things on her own and not let her family know what is going on with her and they are getting extremely frustrated with the lack of information. Your information has been very informative and is right in line with what I had come up with in my research. Thank you very much.
Brief Answer:
Conservative management, under supervision, is all needed at the moment!!!
Detailed Answer:
Welcome back with the details in this follow up query. I feel happy to hear words of appreciation from you. If you are a Mom, I want to extend wishes of "Happy Mother's Day" to you (or anyone at your home who is a Mom)…
Well, as far as her case is concerned, she is having the easy bruisability bleeding issues due to lack of "hepatic synthetic function" and is having vomiting and nausea due to disturbed digestion, toxins accumulation in body and many other factors.
Splenomegaly and all other issues you mentioned are in line with the natural course of the disease and almost every cirrhotic patient happens to have them down the road to end stage liver disease.
She needs to be taken care of by the family. You should convince her that even a Hepatologist can't treat herself in the best possible way. It is always better to get medical as well as social and moral support from family, especially when you are suffering from a fatal disease that alters your mental status too. Patient is unable to make her own decisions for daily life activities.
Keep a balanced and healthy diet for her. Conservative treatment is all what's needed at this time. You need to keep her in touch with her Hepatologist or Gastroenterologist for time to time physical assessment and management accordingly. I wish for the best of times ahead for your family.
I once more appreciate your concerns and consulting here at my virtual clinic. It’s my pleasure to help you for any further assistance if needed regarding her or anyone else's health. For future reference click on my direct link:
Tinyurl.com/drhanifmd
REGARDS!
Conservative management, under supervision, is all needed at the moment!!!
Detailed Answer:
Welcome back with the details in this follow up query. I feel happy to hear words of appreciation from you. If you are a Mom, I want to extend wishes of "Happy Mother's Day" to you (or anyone at your home who is a Mom)…
Well, as far as her case is concerned, she is having the easy bruisability bleeding issues due to lack of "hepatic synthetic function" and is having vomiting and nausea due to disturbed digestion, toxins accumulation in body and many other factors.
Splenomegaly and all other issues you mentioned are in line with the natural course of the disease and almost every cirrhotic patient happens to have them down the road to end stage liver disease.
She needs to be taken care of by the family. You should convince her that even a Hepatologist can't treat herself in the best possible way. It is always better to get medical as well as social and moral support from family, especially when you are suffering from a fatal disease that alters your mental status too. Patient is unable to make her own decisions for daily life activities.
Keep a balanced and healthy diet for her. Conservative treatment is all what's needed at this time. You need to keep her in touch with her Hepatologist or Gastroenterologist for time to time physical assessment and management accordingly. I wish for the best of times ahead for your family.
I once more appreciate your concerns and consulting here at my virtual clinic. It’s my pleasure to help you for any further assistance if needed regarding her or anyone else's health. For future reference click on my direct link:
Tinyurl.com/drhanifmd
REGARDS!
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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