14. Consequences of Missed Opportunities

  1. James C. Pile3,
  2. Thomas E. Baudendistel4 and
  3. Brian J. Harte5
  1. Julia C. Dombrowski1,
  2. Helen Kao1,
  3. Natasha Renda2 and
  4. R. J. Kohlwes1

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch14

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Dombrowski, J. C., Kao, H., Renda, N. and Kohlwes, R. J. (2013) Consequences of Missed Opportunities, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch14

Editor Information

  1. 3

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 4

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 5

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Medicine, University of California, San Francisco, California, USA

  2. 2

    School of Medicine, University of California, San Francisco, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • cancer;
  • cirrhosis;
  • hepatitis C;
  • hepatocellular carcinoma (HCC);
  • infection

Summary

Hepatocellular carcinoma (HCC) is the third-leading cause of cancer death and the fifth-leading cause of cancer worldwide. HCC can metastasize to almost anywhere in the body by hematologic or lymphatic spread or by direct extension. The most common site for metastases of HCC is the lung. Metastases to the lung arise primarily from arterial emboli and therefore are most common in the lower lobes, where there is greater perfusion. The second most common site is the intra-abdominal lymph nodes. The axial skeleton is the third most common site of metastases. Patients infected with hepatitis C who are found to have suspicious hepatic lesions should be aggressively evaluated for HCC. Using an alpha-fetoprotein (AFP) level