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Liver Diseases pp 341-368 | Cite as

Liver Cancer

  • Emilio De RaffeleEmail author
Chapter

Abstract

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) are the most frequent primary malignancies of the liver, with increasing incidence rates worldwide, especially among patients with chronic liver disease. The molecular pathogenesis of liver cancer is complex, although in recent years there has been considerable progress in understanding the mechanisms of hepatic and biliary carcinogenesis. Screening of patients at risk is of paramount importance to diagnose liver cancer at an early stage, when the available treatment strategies are most effective. Liver imaging is rapidly progressing, and the available dynamic imaging techniques usually permit a definite diagnosis without the need of liver biopsy. Pathological diagnosis however is still recommended for all atypical lesions either in cirrhotic or in noncirrhotic patients. Liver resection (LR) and liver transplantation (LT) are potentially curative for HCC and iCCA, but only a minority of patients with early tumour stages are surgical candidates. Minimally invasive percutaneous ablative treatments, including radiofrequency ablation (RFA), ethanol injection (PEI), and other recent techniques, are increasingly used, especially in case of smaller lesions, as an alternative to liver surgery in appropriately selected patients. A variety of locoregional therapies, including transarterial chemoembolization (TACE) and radioembolization (TARE), radiation therapy (RT), and systemic therapies are employed to treat unresectable or recurrent disease. The choice of the most appropriate treatment strategy in the single patient is based on the neoplastic burden and on the liver function, which needs to be accurately evaluated according to the underlying liver disease and to the performance status. Treatment of liver cancer is multidisciplinary and should involve hepatologists, hepato-biliary surgeons, radiologists, including interventional radiologists, and oncologists, to achieve the optimal outcome according to the tumour stage and liver functional reserve.

Keywords

Liver cancer Hepatocellular carcinoma Cholangiocarcinoma Intrahepatic cholangiocarcinoma Liver cirrhosis 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Unità Operativa di Chirurgia Generale, Dipartimento dell’Apparato Digerente, Azienda Ospedaliero-Universitaria di BolognaPoliclinico S. Orsola-MalpighiBolognaItaly

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