Hepatocellular carcinoma: screening and therapy

Treatment of the liver cancer (LC) patient is often problematic as the tumour is identified at an advanced stage: the frequent coexistence of cirrhosis limits the use of surgical resection, there is no efficacious chemotherapy, and in patients treatable with liver transplant, indication is rendered uncertain from the point of view of cost-effectiveness and the high risk of recurrence of the tumour and hepatitis infection. Surgical resection appears to be the treatment of choice in patients with a liver tumour in a ''healthy'' liver. Instead, orthotopic liver transplant is the most valid indication for patients with cirrhosis and tumours of dimensions smaller than 2-3 cm. Nevertheless, due to the lack of organs palliative treatments, like surgical resection, PEI and TACE are the most indicated in patients with advanced neoplastic disease, in practice patients with TNM III and IV; radiotherapy with protons and the coagulation of the tumour by microwaves or laser fibres are also used in the attempt to slow down the progress of the neoplastic process. These methods may increase the possibility of cure in well chosen patients. In some patients the most effective approach may be the combined use of various therapies, such as TACE, PEI and surgery.