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[Epidemiology and diagnosis of hepatocellular carcinomas in cirrhosis]
1Service d'Hépatologie et de Gastroentérologie, Hôpital Henri-Mondor, Créteil.
Insights
Hepatocellular carcinoma (HCC), a common liver cancer, often develops in patients with cirrhosis. Early diagnosis involves imaging and serum markers, with invasive procedures for confirmation.
Area of Science:
- Hepatology and Oncology
- Gastroenterology
- Medical Imaging
Context:
- Hepatocellular carcinoma (HCC) is the most common primary liver cancer globally, particularly prevalent in Asian and African regions.
- HCC frequently arises in individuals with liver cirrhosis, affecting 2-6% annually.
- Key risk factors include male gender, age over 50, macronodular cirrhosis, and large cell dysplasia.
Purpose:
- To outline the epidemiology, risk factors, and diagnostic approaches for hepatocellular carcinoma (HCC).
- To detail current diagnostic methods, including imaging (ultrasound, CT, MRI) and serological markers (alpha-foeto-protein).
- To discuss the role of invasive procedures like fine-needle aspiration and liver biopsy when diagnosis remains uncertain.
Summary:
- HCC is the leading primary liver cancer, with incidence highest in Asia and Africa.
- Diagnosis typically involves identifying focal lesions in cirrhotic livers via ultrasound, confirmed by CT/MRI and elevated alpha-foeto-protein levels.
- Invasive methods like biopsy are reserved for uncertain cases, though future imaging advancements may reduce their necessity.
Impact:
- Provides a comprehensive overview of HCC diagnosis for clinicians and researchers.
- Highlights the importance of early detection in high-risk populations, particularly those with cirrhosis.
- Informs the development of less invasive diagnostic strategies for liver cancer.
Abstract:
Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and the most frequent tumour in males, worldwide. The annual incidence of HCC is maximum in Asian and African countries, lower in western countries where it is close to 4/100,000 inhabitants. In 90% of the cases, HCC complicates course of liver cirrhosis, with an annual incidence in cirrhoties of 2 to 6%. Risk factors for HCC in cirrhotics are male gender (sex-ratio: 4/1), age (above 50 years old), macronodular cirrhosis and large cell dysplasia. HCC can complicate the course of cirrhosis of any cause, but might be less frequent in primary biliary cirrhosis, Wilson's disease and auto-immune hepatitis. Currently, the diagnosis of HCC is usually considered in the presence of a focal nodular lesion, during systematic ultrasonographic examination of the liver. In high incidence areas, HCC can still be diagnosed because of HCC-related symptoms. In the case of a focal lesion discovered on a cirrhotic liver, the diagnosis of HCC can be confirmed by studying the behaviour of the lesion of helical CT scan of the liver (enhancement of the tumour during the arterial phase) or MRI (hyperintensity of the tumour on T2 relaxation time); study of peritumour vessels can also be helpful. Serum alpha-foeto-protein level, when higher than 300 to 500 micrograms/L is very specific of HCC. When aggressive treatment of HCC is considered and when the diagnosis of HCC remains uncertain, HCC can be assessed by means of cytological or histological study of the tumour on samples taken by fineneedle aspiration (80% sensitivity) or liver biopsy during laparoscopic laparotomy. Forthcoming improvements in imaging technology might eliminate the need for such invasive diagnostic techniques in the future.