Hepatocellular carcinoma (HCC) – a role of surgical resection and liver transplantation for the treatment of HCC
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 1
Abstract
Hepatocellular carcinoma (HCC) is one of the common malignant tumors worldwide and is the fifth leading cause of death on a worldwide basis. The major risk factors for development of HCC are now well defined: cirrhosis, regardless of etiology, chronic viral hepatitis B,C and D, toxins and drugs(e.g. alcohol, aflatoxins, anabolic steroids) and metabolic liver diseases (e.g., hereditary hemochromatosis, alfa1-antitrypsin deficiency). Clinical presentation is not typical and different, depending on stage at discovery, and hepatic dysfunction, and the geographic location of the patient. Routine imaging with USG, CT scan and MRI is the diagnostic procedure and follow abnormal laboratory tests. Many centers employed the screening protocol(AFP test, ultrasound) to detect and to determine the stage cancer early. This strategy allow selection of optimal treatment procedure and reduce mortality. The optimal treatment for HCC is surgical resection with the curative intent. Percutaneous ethanol injection has been widely performed as an alternative to surgery in patients with small HCCs. Radiofrequency ablation produces thermal destruction with an electric current that passes to the tumor via electrode tip, resulting in heat generation and coagulative necrosis. Transcatheter arterial chemoembolisation is one of the popular and effective treatments for patients with unresectable HCC. Targeted therapy ( monoclonal antybodies, receptor kinase inhibitors) may inhibits tumor progression. Liver transplantation is an therapeutic option in patients with HCC. The treatment of HCC by liver transplantation has evolved during decades in term to determine the best criteria of patients selection and optimal treatment protocols pre- and posttransplantation. Preoperative diagnostic should be as extensive as needed to accurately assess the morphological and biological characteristics of tumor – criteria for transplant candidacy. Adjuvant chemotherapy is a part of treatment protocols in many centers. It is evident from the published results that liver transplantation is the best chance for cure in patients with early HCC. The important factor in reducing of metastatic disease occurrence after ltx is optimal immunosuppressive regimen. The further efforts should be made to improve the results of liver transplantation.
Authors and Affiliations
Marek Krawczyk, Urszula Ołdakowska-Jedynak
Keywords
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