Primary liver cancers

A review of the recent literature about liver cancers shows the increasing role of hepatitis C as a risk factor for the development of hepatocellular carcinoma. A new discussion has arisen with regard to the association between the use of oral contraceptives and hepatocellular carcinoma. Patients at risk for developing liver cancer can be identified and should undergo thorough follow-up to detect cancer at an early stage. Surgical resection remains the treatment of choice whenever feasible. Because of disappointing results and limited availability of donor organs, liver transplantation must be considered only in selected patients with unresectable tumors. There are also arguments recommending transplantation in early resectable hepatocellular carcinoma in patients with cirrhosis to cure the underlying cancer-bearing disease. Improvement of survival can be expected by promising multimodality treatment protocols that have been started during the past few years. Further studies should also investigate the role of immunosuppression in the treatment of tumor recurrence. For patients excluded from resection and transplantation, the most effective treatment options are transarterial chemoembolization and, in small lesions, percutaneous ethanol injection therapy. In small tumors, combination therapy seems to be even more appropriate.