Hepatocellular carcinoma: Diagnosis and treatment☆
Section snippets
Clinical features
The classic clinical features of HCC include right upper quadrant pain and weight loss. Other clinical scenarios that suggest this diagnosis include worsening liver function in a patient known to have cirrhosis, acute abdominal catastrophe from rupture of a liver tumor with intra-abdominal bleeding, and some rare extrahepatic manifestations. More and more commonly though, patients are being diagnosed with HCC at an asymptomatic stage while they are being evaluated for liver transplantation or
Staging of HCC
After making the diagnosis of HCC, the next step in the management of the patient is staging. The goal of cancer staging is to separate patients into different groups based on their predicted survival to help determine the most appropriate treatment modality. Patients within a particular stage should have a homogenous survival that is clearly different from the survival in other stages. HCC is different from other cancers because survival is not predominantly based on biology of the tumor, but
Liver transplantation
OLT is theoretically the best treatment for HCC because it results in the widest possible resection margins for the cancer, removes the remaining liver tissue that is at risk for the development of de novo cancer, and restores hepatic function. Unfortunately, the limited availability of donor organs with the resulting delay to transplantation makes OLT less effective and less available to individual patients. Living donor transplantation eliminates many of these obstacles if the patient has a
Hepatic resection
Liver resection treats HCC by surgically removing the portion of the liver involved with cancer. It is second only to transplantation in its ability to effectively eliminate the cancer, but has the disadvantage of not eliminating remaining portions of the liver at risk for malignant transformation and neither does it improve hepatic function. For patients without cirrhosis who have technically resectable cancers and no evidence of vascular invasion or spread outside of the liver, resection is
Summary and conclusions
HCC remains a major problem worldwide and appears to be increasing in developed Western countries. Recent advances in diagnosis include the use of 3-phase spiral CT scanning and progress in the use of magnetic resonance imaging. Better imaging has allowed more frequent diagnosis of HCC when tumors are still small. Smaller tumors are more amenable to potentially curative treatments, such as resection, ablation, and liver transplantation. Liver transplantation has become established as an
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Address requests for reprints to: Adrian M. Di Bisceglie, M.D., Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Avenue, St. Louis, Missouri 63110.