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.
KeywordsLiver Resection Transcatheter Arterial Embolization Cirrhotic Liver Focal Nodular Hyperplasia Chronic Viral Hepatitis
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