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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A patient with ER-positive, HER2-negative metastatic breast cancer has extensive liver metastases. Which finding meets the ABC5 example of hepatic visceral crisis rather than merely high visceral tumour burden or impending crisis?

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Correct answer: D — Rapid bilirubin rise above 1.5 times normal without obstruction or Gilbert syndrome

ABC5 defines hepatic visceral crisis by a rapidly increasing bilirubin above 1.5 times the upper limit of normal in the absence of Gilbert syndrome or biliary obstruction. Heavy hepatic replacement with abnormal transaminases but normal bilirubin is an example of impending rather than established crisis. Visceral metastases, tumour-marker rise or non-specific biochemical abnormalities alone do not establish severe organ dysfunction.

Reference: ABC5 consensus assessment: definition of visceral crisis (Published March 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC7098316/