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Abstract
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Chronic
infection with hepatitis B virus and hepatitis C virus are major risk
factors for hepatocellular carcinoma (HCC). HCC risk is particularly
high in carriers with high liver cell proliferative activity and those
with advanced liver disease. HCC often develops as a slowly growing
single nodule. However, 40% of the patients have more than one HCC
nodule when the tumor is first detected by imaging. Some tumors may
rapidly grow. Screening with serum alphafetoprotein and abdominal
ultrasound leads to identification of many patients with small, potentially
operable tumors. However, it is not clear whether mortality from HCC
is reduced in parallel. Treatment of HCC depends largely on the stage
of the tumor and cirrhosis, but is limited overall by the lack of
efficient chemotherapy. Transplantation offers the best chances of
cure for small tumors. However, intention-to-treat reanalysis of the
results yielded less encouraging figures than previously thought.
Different locoregional treatment modalities may palliate/control the
tumor disease in patients who are not eligible for operation. The
5-year survival of inoperable patients with a small HCC and compensated
cirrhosis was approximately 50%. The substantial heterogeneity of
survival between control groups makes it impossible to compare the
results of individual trials. |
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Leadership Medica® |
