title: How can we treat a patient with liver cirrhosis (hepatitis C virus), hepatocellular carcinoma, and synchronous colon cancer?
abstract: BACKGROUND
  The coexistence of liver cirrhosis with hepatocellular carcinoma (HCC) and colon cancer (Ca), which is a rare clinical condition, was treated in a liver transplant recipient.
  
  
  METHODS
  A 46-year-old man, diagnosed incidentally during an ultrasound (US) examination with a 3.5-cm HCC in segment VII related to chronic hepatitis C virus (HCV), was referred for liver resection. He underwent a laparoscopic protocol evaluation for liver cirrhosis. Liver appearance and biopsy of the left lobe showed Child B/C liver cirrhosis. Because he fulfilled the Milan criteria, we suggested an orthotopic liver transplantation (OLT). During protocol colonoscopy, we discovered an ulcerative sigmoid colon Ca. Three weeks after completing the pre-OLT assessment he underwent an OLT and was discharged home on day 9 on an immunosuppressive regimen of Everolimus, Myfortic, and Prezolone. Two months after transplantation, the patient underwent a sigmoidectomy and for nearly 1 month thereafter received chemotherapy for colon Ca (6 cycles of FOLFOX:Folinic Acid+Fluorouracil+Oxaliplatin). One and a half years after OLT, patient was in good condition but presented with an increased alpha fetoprotein (a-FP) without other findings. A couple of months later we discovered a colon Ca recurrence and 3 small liver metastases. Patient underwent a bowel resection with Hartmann's procedure. Almost immediately after the last operation, he was found to suffer multiple myeloma. He underwent chemotherapy for both malignancies with good responses, but a few months later died of severe sepsis.
  
  
  CONCLUSIONS
  The relevant literature regarding treatment of liver cirrhosis complicated with HCC and synchronous colon Ca reveals poor and controversial outcomes. Our patient underwent chemotherapy immediately after colon resection in the presence of with a good functioning liver. Although his condition was satisfactory after OLT, the optimal treatment of such complicated patients is as yet uncertain.
authors.affiliation: 2nd Department of Propaedutic Surgery, School of Medicine, University of Athens, "Laikon" Hospital, Athens, Greece. e.a.antoniou@doctors.org.uk
authors.forename: E
authors.initials: E
authors.lastname: Antoniou
authors.forename: D
authors.initials: D
authors.lastname: Mantas
authors.forename: P
authors.initials: P
authors.lastname: Paraskeva
authors.forename: D
authors.initials: D
authors.lastname: Dimitroulis
authors.forename: A
authors.initials: A
authors.lastname: Smyrnis
authors.forename: N
authors.initials: N
authors.lastname: Nikitakis
authors.forename: A
authors.initials: A
authors.lastname: Labadariou
authors.forename: N
authors.initials: N
authors.lastname: Tsavaris
authors.forename: P
authors.initials: P
authors.lastname: Vernicos
authors.forename: A
authors.initials: A
authors.lastname: Kostakis
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery* / Q000821:virology*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy; D017809:Fatal Outcome; D005472:Fluorouracil; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D033162:Incidental Findings; D002955:Leucovorin; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary; D009944:Organoplatinum Compounds; D018805:Sepsis / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil