%0 Journal Article
%T Contemporary Strategies in the Management of Hepatocellular Carcinoma
%A Shirin Elizabeth Khorsandi
%A Nigel Heaton
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/154056
%X Liver transplantation is the treatment of choice for selected patients with hepatocellular carcinoma (HCC) on a background of chronic liver disease. Liver resection or locoregional ablative therapies may be indicated for patients with preserved synthetic function without significant portal hypertension. Milan criteria were introduced to select suitable patients for liver transplant with low risk of tumor recurrence and 5-year survival in excess of 70%. Currently the incidence of HCC is climbing rapidly and in a current climate of organ shortage has led to the re-evaluation of locoregional therapies and resectional surgery to manage the case load. The introduction of biological therapies has had a new dimension to care, adding to the complexities of multidisciplinary team working in the management of HCC. The aim of this paper is to give a brief overview of present day management strategies and decision making. 1. Introduction Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. Ninety percent of primary liver cancers are HCC, the majority of which develop on the background of cirrhosis. Over the past decade, medical management of the patient with chronic liver disease has improved. In parallel, the prevalence of hepatitis B (HBV), hepatitis C virus (HCV), alcohol related liver disease, and NASH has increased and combined with an ageing population has led to a surge in the number of cases worldwide [1¨C3]. As a consequence, HCC is an important complication of cirrhosis and a leading indication for liver transplantation (LT), accounting for approximately a third of patients on transplant waiting lists [4]. The introduction of surveillance using alphafetoprotein and ultrasound has led to the earlier recognition of HCC and increases the therapeutic options available [5]. In the absence of treatment the overall 5-year survival is <10% [6]. These include LT, resection, locoregional, and systemic therapies. For a solitary HCC with preserved liver function and low hepatic vein pressure gradient, liver resection still remains the first choice. Historically, survival rates were 35¨C62% at 3 years and 17¨C50% at 5 years for patients with cirrhosis undergoing resection for HCC [6, 7]. However, tumor recurrence rates were high, up to 70%, and progression to liver failure was common [6, 8¨C10]. LT is an attractive treatment option as it treats both the cancer and underlying liver disease. In the 1980s, patients presenting with large HCC were considered good candidates for LT as they were in better condition than patients with chronic liver disease
%U http://www.hindawi.com/journals/hpb/2012/154056/