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Screening and treatment for hepatocellular carcinoma
Morris Sherman1, Yuji Takayama
1Department of Medicine, University of Toronto and Toronto General Hospital, EN9-223, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. morrissherman@globalserve.net
Gastroenterology Clinics of North America
|August 25, 2004
Summary
Routine surveillance for hepatocellular carcinoma (HCC) is common but lacks efficacy evidence. Ultrasonography every 6-12 months is the best screening test for at-risk patients, including those with cirrhosis.
Area of Science:
- Hepatology
- Oncology
- Diagnostic Imaging
Background:
- Surveillance for hepatocellular carcinoma (HCC) is widely practiced, yet its efficacy remains unproven.
- Current guidelines recommend surveillance for patients with cirrhosis and specific noncirrhotic chronic hepatitis B carriers.
Purpose of the Study:
- To review the current evidence regarding the efficacy and methods of hepatocellular carcinoma (HCC) surveillance.
- To outline diagnostic and treatment strategies for HCC detected through surveillance.
Main Methods:
- Review of existing literature on HCC surveillance, diagnosis, and treatment.
- Analysis of the effectiveness of ultrasonography and serological tests for HCC detection.
- Evaluation of treatment options including liver transplantation, resection, ablation, and chemoembolization.
Main Results:
- Ultrasonography at 6- to 12-month intervals is considered the most effective surveillance method.
- Serological tests are less effective, and defining abnormal results in cirrhotic livers is challenging.
- Diagnosis confirmation may require radiological investigations and biopsy for lesions between 1-2 cm.
- Liver transplantation offers the best curative treatment for suitable HCC lesions.
Conclusions:
- While surveillance for HCC is routine, robust evidence of its efficacy is lacking.
- Ultrasonography is the preferred surveillance modality, requiring enhanced follow-up for abnormal results.
- Liver transplantation, resection, and ablation are curative treatment options, with transplantation being optimal for eligible patients.