Advertisement

Hepatocellular Carcinoma

  • M. Scheurlen
  • H.-J. Brambs
  • H.-J. Gassel

Abstract

Hepatocellular carcinoma (HCC) is one of the most frequent tumors worldwide. Its etiology is dominated by exogenous factors. Liver cirrhosis due to chronic viral hepatitis, or hereditary hemochromatosis is most frequently associated with the disease. HCC occurs in a non-cirrhotic liver only very rarely. Because the underlying disease may dominate the clinical picture, signs of an early tumor may be missed.

The most important diagnostic tools are abdominal ultrasound (US), contrast-enhanced computed tomography and magnetic resonance tomography. Alpha-fetoprotein (AFP) is elevated in up to 90% of HCC cases, but specificity is reduced because of the co-existing cirrhosis.

Surgical removal of the tumor, either by partial hepatectomy or by liver transplantation, offers the best chance for cure. However, several minimally invasive local procedures, aiming at either chemical or thermal ablation of malignant tissue under sonographic or radiological control, have also been shown to result in the complete destruction of small HCCs. Antineoplastic chemotherapy is ineffective in HCC, and no effective palliative, adjuvant or neoadjuvant strategies are available. Other therapies with tamoxifen, octreotide, megestrol or pravastatin are at present under investigation or have already been shown to be ineffective.

Keywords

Liver Resection Transcatheter Arterial Embolization Cirrhotic Liver Focal Nodular Hyperplasia Chronic Viral Hepatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lo CM, Ngan H, Tso WK, et al: Randomized controlled trial of trans-arterial lipiodol chemoembolisation for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171Google Scholar
  2. 2.
    Mori K, Scheidler J, Helmberger T, Holzknecht N, Schauer R, Schirren CA, Bittmann I, Dugas M, Reiser M: Detection of malignant hepatic lesions before orthotopic liver transplantation: accuracy of ferumoxides-enhanced MR imaging. Am J Roentgenol 179:1045–1051, 2002Google Scholar
  3. 3.
    Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A (1993) Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 218: 145–151PubMedCrossRefGoogle Scholar
  4. 4.
    Poon RTP, Fan ST, Lin IO, Wong J (2000) Significance of resection margin in hepatectomy for hepatocellular carcinoma. Ann Surg 231: 544–551PubMedCrossRefGoogle Scholar
  5. 5.
    Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, Sugimachi K (1999) Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg 188:304–307PubMedCrossRefGoogle Scholar
  6. 6.
    Neuhaus P, Jonas S, Bechstein WO (2000) Hepatoma of the liver-resection or transplantation? Langenbeck’s Arch Surg 385: 171–178CrossRefGoogle Scholar
  7. 7.
    Cammà C, Schepis F, Orlando A, Albanesem, Shahied l, Trevisani F, Androne P, Craxi, Cottone M: Transarterial chemoembolisation for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54, 2002PubMedCrossRefGoogle Scholar
  8. 8.
    Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS: Small hepatocellular carcinoma. Treatment with radio-frequency ablation versus ethanol injection. Radiology 210:655–661, 1999PubMedGoogle Scholar
  9. 9.
    Befeler AS, di Bisceglie A (2002) Hepatocellular Carcinoma: Diagnosis and Treatment. Gastroenterology 122:1609–1619PubMedCrossRefGoogle Scholar
  10. 10.
    Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524PubMedCrossRefGoogle Scholar
  11. 11.
    Fujiyama S, Tanaka M, Maeda S, Ashihara H, Hirata R, Tomita K (2002) Tumor markers in early diagnosis, follow-up and management of patients with hepatocellular carcinoma. Oncology 62 Suppl 1:57–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Okuda K (2002) Natural history of hepatocellular carcinoma including fibrolamellar and hepato-cholangiocarcinoma variants. J Gastroenterol Hepatol 17:401–405.PubMedCrossRefGoogle Scholar
  13. 13.
    Peterson MS, Baron RL, Marsh JW, Oliver JH, Confer SR, Hunt LE: Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology 217:743–749, 2000.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • M. Scheurlen
    • 1
  • H.-J. Brambs
    • 2
  • H.-J. Gassel
    • 3
  1. 1.Bayerische Julius-Maximilians-Universität, Medizinische PoliklinikWürzburgGermany
  2. 2.Abteilung für Diagnostische RadiologieUniversität Ulm, Radiologische UniversitätsklinikUlmGermany
  3. 3.Bayerische Julius-Maximilians-Universität, Chirurgische UniversitätsklinikWürzburgGermany

Personalised recommendations