Dai, 77, had cirrhosis but neglected treatment and consumed excessive alcohol. He sought medical attention at Tam Anh Cau Giay General Clinic after experiencing bloody stools. Endoscopy revealed a fungating tumor in his ascending colon. A CT scan showed a tumor larger than 6 cm, and a biopsy confirmed colorectal adenocarcinoma.

Associate Professor Doctor Trieu Trieu Duong, Director of Surgery, stated that Dai was diagnosed with stage three colon cancer, alongside multiple underlying conditions including high blood pressure and compensated cirrhosis.

The patient underwent six cycles of neoadjuvant chemotherapy over five months in the Oncology Department. This treatment protocol aimed to minimize impact and toxicity to his liver before surgery.

Dai's colon tumor shrank after neoadjuvant chemotherapy. Photo: Tam Anh General Hospital

After eight weeks of neoadjuvant chemotherapy, a follow-up CT scan showed that the tumor and lymph nodes had shrunk, indicating a reduction in cancer stage. Consequently, doctors scheduled curative colon resection. However, a side effect of the chemotherapy caused Dai's cirrhosis to progress to the decompensated stage.

Before surgery, Dai received intensive liver resuscitation, including albumin infusions, liver function support medication, liver enzyme reduction, intravenous nutrition, and a tailored diet. These measures aimed to mitigate risks such as liver failure, edema, and anastomotic leaks post-surgery. He also received vitamin K to improve coagulation function, participated in an enhanced recovery after surgery (ERAS) protocol, and was given prophylactic antibiotics to reduce complication and infection risks.

After 10 days, Dai was deemed fit for surgery. Anesthesiologists administered endotracheal anesthesia using selective medications that had minimal impact on the liver, preventing critical intraoperative hypotension.

The surgical team opted for open surgery to gain full control of the abdominal cavity and proactively manage potential risks such as liver failure or bleeding from venous ruptures. This approach also helped shorten surgical time and reduce anesthetic dosage.

Following optimal pre-operative preparation, the team resected the segment of the colon containing the tumor along with the mesentery, performed lymph node dissection, and then created a colon-small intestine anastomosis.

Post-surgery, Dai recovered well, experienced minimal pain, and was able to walk after four days. His liver function stabilized, and he was discharged after 10 days. The pathology report confirmed that the resection margins and lymph nodes were free of cancer cells, eliminating the need for adjuvant chemotherapy.

Associate Professor Duong (third from left) performing surgery on Dai. Photo: Tam Anh General Hospital

Associate Professor Duong noted that heavy alcohol consumption is a common cause of cirrhosis, which increases cancer risk. According to 2024 statistics from the World Health Organization (WHO), Vietnam leads Southeast Asia in alcohol consumption.

Patients suffering from both cirrhosis and cancer often face significant treatment challenges. Many are diagnosed with cancer when their liver cirrhosis has already decompensated, leaving them without the option for curative surgery.

To prevent cirrhosis and cancer, people should limit alcohol, avoid smoking, and maintain a healthy diet. Individuals with cirrhosis should seek regular medical check-ups and adhere to treatment plans to prevent disease progression.

Thanh Long

*Patient's name has been changed