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Liver Disease in Clinical Practice pp 285–306Cite as

Diagnosis and Management of Hepatocellular Carcinoma

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Part of the book series: In Clinical Practice ((ICP))

Abstract

A 57-year-old man with cirrhotic genetic haemochromatosis (GH) attends the radiology department for his 6-monthly liver ultrasound scan. The scan shows two lesions which had not previously been seen measuring 19 mm and 29 mm, respectively. He is otherwise well and has no other comorbidities. His blood results are as follows: albumin 44 g/dL, AST 36 IU/L, bilirubin 15 μmol/L, creatinine 87 μmol/L, sodium 143 mmol/L, alpha-fetoprotein 4 μmol/L, platelet count 67 × 109/L and PT 12 s.

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References

  1. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.

    Article  PubMed  Google Scholar 

  3. Cross TJ, Rizzi P, Horner M, Jolly A, Hussain MJ, Smith HM, et al. The increasing prevalence of hepatitis delta virus (HDV) infection in South London. J Med Virol. 2008;80(2):277–82.

    Article  PubMed  Google Scholar 

  4. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208–36.

    Article  PubMed  Google Scholar 

  6. International Consensus Group for Hepatocellular Neoplasia, The International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology. 2009;49(2):658–64.

    Article  Google Scholar 

  7. Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther. 2009;30(1):37–47.

    Article  CAS  PubMed  Google Scholar 

  8. Zhang B, Yang B. Combined alpha fetoprotein testing and ultrasonography as a screening test for primary liver cancer. J Med Screen. 1999;6(2):108–10.

    Article  CAS  PubMed  Google Scholar 

  9. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35(3):421–30.

    Article  CAS  PubMed  Google Scholar 

  10. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology. 1998;28(3):751–5.

    Google Scholar 

  11. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.

    Article  CAS  PubMed  Google Scholar 

  12. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology. 2014;146(7):1691–700 e3.

    Article  PubMed  Google Scholar 

  13. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–403.

    Article  CAS  PubMed  Google Scholar 

  14. Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant. 2007;7(11):2587–96.

    Article  CAS  PubMed  Google Scholar 

  15. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35–43.

    Article  PubMed  Google Scholar 

  16. Hucke F, Sieghart W, Pinter M, Graziadei I, Vogel W, Muller C, et al. The ART-strategy: sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE. J Hepatol. 2014;60(1):118–26.

    Article  PubMed  Google Scholar 

  17. Kadalayil L, Benini R, Pallan L, O’Beirne J, Marelli L, Yu D, et al. A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol. 2014;24(10):2565–70.

    Article  Google Scholar 

  18. Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T, et al. Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterology. 2012;143(4):986–94 e3; quiz e14-5.

    Article  CAS  PubMed  Google Scholar 

  19. Gotzsche PC, Olsen O. Is screening for breast cancer with mammography justifiable? Lancet. 2000;355(9198):129–34.

    Article  CAS  PubMed  Google Scholar 

  20. Cross TJS, Villaneuva A, Shetty S, Wilkes E, Reeves H, et al. A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma. Frontline gastroenterol. 2016;7:82–9.21.

    Article  Google Scholar 

  21. Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11–22.

    Article  PubMed  Google Scholar 

  22. Samoylova ML, Dodge JL, Yao FY, Roberts JP. Time to transplantation as a predictor of hepatocellular carcinoma recurrence after liver transplantation. Liver Transpl. 2014;20(8):937–44.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Majno P, Lencioni R, Mornex F, Girard N, Poon RT, Cherqui D. Is the treatment of hepatocellular carcinoma on the waiting list necessary? Liver Transpl. 2011;17 Suppl 2:S98–108.

    Article  PubMed  Google Scholar 

  24. Merani S, Majno P, Kneteman NM, Berney T, Morel P, Mentha G, et al. The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma. J Hepatol. 2011;55(4):814–9.

    Article  CAS  PubMed  Google Scholar 

  25. Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl. 2014;20(8):945–51.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37(2):429–42.

    Article  CAS  PubMed  Google Scholar 

  27. Chen HP, Shieh JJ, Chang CC, Chen TT, Lin JT, Wu MS, et al. Metformin decreases hepatocellular carcinoma risk in a dose-dependent manner: population-based and in vitro studies. Gut. 2013;62(4):606–15.

    Article  CAS  PubMed  Google Scholar 

  28. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90.

    Article  CAS  PubMed  Google Scholar 

  29. Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63(5):844–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Abou-Alfa GK, Johnson P, Knox JJ, Capanu M, Davidenko I, Lacava J, et al. Doxorubicin plus sorafenib vs doxorubicin alone in patients with advanced hepatocellular carcinoma: a randomized trial. JAMA. 2010;304(19):2154–60.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Royal Liverpool Hospital, Prescot Street, Liverpool, L7 8XP, UK

    Tim Cross BMedSci (hons), MD, FRCP

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  1. Tim Cross BMedSci (hons), MD, FRCP
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Correspondence to Tim Cross BMedSci (hons), MD, FRCP .

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  1. Royal Liverpool University Hospital, Liverpool, Merseyside, United Kingdom

    Tim Cross

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© 2017 Springer International Publishing Switzerland

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Cross, T. (2017). Diagnosis and Management of Hepatocellular Carcinoma. In: Cross, T. (eds) Liver Disease in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-43126-0_16

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  • DOI: https://doi.org/10.1007/978-3-319-43126-0_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43125-3

  • Online ISBN: 978-3-319-43126-0

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