Huge Hepatocellular Carcinoma in a Geriatric Patient with Normal Alfa-feto Protein Levels: A Case Report

Hepatocellular carcinoma (HCC) is a common type of liver cancer and is a widespread cause of death from malignancy worldwide. The diagnosis of HCC is made by radiological liver imaging and the presence of serum alfa- fetoprotein. Our patient, a 75-year-old man, had a mass (14*17 cm) in the right liver lobe. Serum alfa-fetoprotein (AFP) was normal. There were no signs of metastasis except for several suspicious subcentimetric lymph nodes. Diagnosis of HCC confirmed by liver biopsy. He was evaluated by a multidisciplinary team. The team favored Yttrium-90 radioembolization treatment. The tumor showed slight regression. However, a new subcentimetric nodule was detected in the posterior segment of the left lower lobe of the lung. Sorafenib was initiated as a salvage drug by medical oncology. In conclusion, this case shows that with HCC can present with normal AFP levels even in advanced diseases. Biomarkers other than AFP are believed to contribute to HCC tumor growth. Moreover, we can infer from this case that the tumor shows less aggression in HCC patients with normal AFP levels. The treatment of HCC should be based on the patient's age and comorbidities. Keywords: Hepatocellular carcinoma, serum alfa-fetoprotein, geriatric oncology, cancer management, older patient