[Alcoholic liver cirrhosis. Treatment of hepatocellular carcinoma]

TRANSPLANTATION AND RESECTION: Surgery is still the only curative treatment of hepatocellular carcinoma (HCC). For patients with cirrhosis, liver transplantation for HCC with one nodule less than 5 cm in diameter, or no more than three nodules each less than 3 cm, gives the best results with a 5-year survival rate of 70%. Resection of a single tumor for patients with good liver function may also be performed with curative intent but the rate of recurrence is high. OTHER TECHNIQUES: Cryotherapy and radiofrequency are in-situ destruction methods used for small tumors. In the future, these procedures may compete with hepatic resection. When used alone, intra-arterial treatments, such as chemoembolisation, have only a palliative intent, but they also may be combined with other procedures. The treatment of advanced HCC is still limited and there is no standard approach for its management. HCC WITHOUT CIRRHOSIS: For those with HCC without cirrhosis, the same treatments are available but resection is more often performed because of the ability of the liver to regenerate. The management of patients with HCC with or without cirrhosis may combine several treatment modalities and needs a multi-disciplinary approach.