Posted: August 8, 2012

A fifty-year-old man saw his family doctor complaining of a pain in his side.  A native of Vietnam he had lived in the United States since 1975.  From the time he moved here and sought medical attention it was noted that he had minimally abnormal liver function tests indicating chronic liver injury.

In the 1980’s his family doctor obtained additional blood tests that revealed he had chronic Hepatitis B with evidence of active infection.  No further action was taken. Over the next twenty years his liver tests remained mildly abnormal. He voiced no complaints referable to his liver and on physical examination his liver was never tender or enlarged.

At the time of this visit to his primary care physician (PCP) he had marked tenderness in the right upper quadrant of the abdomen and a slightly enlarged liver particularly in the most lateral aspect of the liver, corresponding to the right lobe.

Concerned about these new findings his doctor ordered an ultrasound that revealed a ten-centimeter (four-inch) tumor in the right lobe of his liver and a one cm tumor in the left lobe.  He was referred to a liver specialist, who ordered an alpha-feto protein blood test for liver cancer. The test result was 41,000, with upper limit of normal 25. A liver biopsy showed hepatocellular carcinoma (HCC). He was referred to an oncologist and placed on the liver transplant list through UNOS, the national clearinghouse for organ availability (typically hearts, kidneys and livers).

He was treated with the best available drug treatment for his cancer but died before a liver became available. Before his death he sued his PCP for not screening him for liver cancer and not referring him for anti-viral therapy. His family carried on the suit after his death.

+ Read the whole story from Dr. James Stark on the BS757 Blog.