[What possible treatments for liver cirrhosis patients with a small hepatocellular carcinoma?]

UNDERLYING LIVER DISEASE: Most cases of hepatocellular carcinoma (HCC) develop in subjects with an underlying chronic liver disease, primarily hepatitis C infection. The underlying liver disease greatly limits treatment possibilities due to the restrictions on surgery or the risk of recurrence even when surgical resection, chemoembolization or alcoholization appears to be successful. IN CASE OF NORMAL LIVER FUNCTION: Percutaneous destruction of the tumor with alcoholization or radiofrequency techniques can be effective against HCC tumors measuring less than 3 cm. Access is however sometimes limited, leading to partial destruction and risk of local recurrence. When the patient's liver functions are compatible with surgery, resection of the tumor and its adjacent portal segment has been found to be effective against tumors measuring 3 to 5 cm.

Liver transplantation is by far the most effective treatment for HCC, treating both the carcinoma and the underlying liver disease. Indications are however limited to patients with at most 3 tumors measuring less than 3 cm with no portal involvement and who can be expected to tolerate the major surgery. In addition, the absence of tumoral extension while waiting for transplantation is an important factor.