Primary carcinoma of the liver: diagnosis, prognosis, and management

Hepatoma accounts for less than 2% of all cancer death in this country, but it is responsible for 10-20% lethal malignancy in Asia and Africa. There are racial differences in its clinical manifestation, association with cirrhosis and/or hepatitis viral infection, pattern of spread, and prognosis. Mass screening program in China using alpha-fetal protein test has detected earlier cases, improved resectability and cure rate. About 10-15% of the patients in this country had surgical treatment. For patients with locally advanced and unresectable carcinoma, regional therapies such as infusion chemotherapy (IA hepatic or IV portal), ligation of hepatic artery, radiotherapy (external or internal), immunotherapy, either singularly or in various combinations have been tried. Despite the availability of Adriamycin and newer combinations of chemotherapeutic agents, patients with disseminated disease rarely respond. Other than earlier diagnosis, search for more effective drugs and multinodal approaches should be continued.