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Hepatocellular Carcinoma: Epidemiology, Basic Principles of Treatment, and Clinical Data

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Book cover Radiation Therapy for Liver Tumors

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Abstract

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide and one of the most common causes of death in patients with cirrhosis. The highest HCC incidence rates are in Southeast Asia and Africa, related to high rates of endemic hepatitis B infection; however, these rates are declining with more widespread vaccination and treatment programs. Its incidence in the USA and Europe is rising due to the current epidemic of hepatitis C infection and non-alcoholic fatty liver disease. HCC surveillance is recommended in high-risk populations, such as those with cirrhosis, to detect HCC at an early stage when curative options exist. Radiologic imaging is the most important aspect of diagnostic evaluation for patients with suspected HCC, as it can facilitate HCC diagnosis, without a need for biopsy, and provides determination of tumor burden. However, biopsy still plays an important role in patients with lesions that do not have characteristic appearance on imaging. Although there is not one universally accepted staging system, the Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely accepted as it includes a proposed treatment algorithm. Although there are treatment options for most patients with any stage of disease, curative treatments are only available for those found at an early stage. Patients diagnosed with early stage HCC achieve 5-year survival rates approaching 70% with resection or liver transplantation compared to a median survival of 1 year for those with advanced HCC. Treatment decisions must be individualized after accounting for factors such as degree of liver dysfunction and patient performance status, and multidisciplinary care has been demonstrated to improve treatment delivery and stage-by-stage survival.

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Authors and Affiliations

  1. Department of Internal Medicine, UT Southwestern Medical Center, 5959 Harry Hines Blvd, P.O. Box 1, Suite 420, Dallas, TX, 75390, USA

    Amit G Singal MD, MS

  2. Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA

    Purva Gopal MD, MS

  3. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Adam C Yopp MD

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  1. Amit G Singal MD, MS
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Correspondence to Amit G Singal MD, MS .

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  1. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Jeffrey Meyer

  2. Department of Radiation Oncology, University of Colorado Comprehensive Cancer Center, Aurora, Colorado, USA

    Tracey Schefter

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Singal, A.G., Gopal, P., Yopp, A.C. (2017). Hepatocellular Carcinoma: Epidemiology, Basic Principles of Treatment, and Clinical Data. In: Meyer, J., Schefter, T. (eds) Radiation Therapy for Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-54531-8_13

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