Hepatocellular carcinoma - diagnosis and treatment

Maciej Krzakowski, Krzysztof Zieniewicz, Andrzej Habior, Andrzej Horban, Włodzimierz Olszewski, Janusz Cianciara, Krzysztof Simon, Marek Hartleb, Jarosław Reguła, Ryszard Pacho, Olgierd Rowiński, Bogna Ziarkiewicz-Wróblewska, Marek Krawczyk, Piotr Małkowski, Jacek Jassem

Abstract

Hepatocellular carcinoma usually is a consequence of underlying viral hepatitis. Both, the incidence and
mortality rates have increased in recent decades. The majority of patients are still diagnosed with advanced
disease. The identifiable population at risk of development malignancy makes early detection a realistic
possibility and every 6 months liver imaging is currently recommended for patients with cirrhosis. The diagnosis
should be based on clinical findings together with radiologic imaging and microscopic examination.
Resection is preferred treatment for patients with the disease confined to one region of the liver and preserved
hepatic function with no evidence of portal hypertension. Liver transplantation is the best option for
small lesions found in cirrhosis. Chemoembolization and thermoablation are effective methods of treatment
of small - up to 3 cm in diameter - lesions in patients who otherwise are not candidates for resection or as
a bridge to liver transplantation. Systemic chemotherapy is of marginal value, whereas the use of sorafenib
- a small-molecule angiogenesis inhibitor - may prolong survival in well-selected patients.

Keywords

hepatocellular carcinoma; liver resection; liver transplatation; systemic therapy

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