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Multi-disciplinary Approach to HCC

The treatment of hepatocellular carcinoma (HCC) is quite challenging and requires a multi-disciplinary approach. A recent review of patients with HCC indicated that, of the population at risk for HCC, 23.9% were due to hepatitis C virus (HCV), approximately 10% were due to hepatitis B virus (HBV), and approximately 41% related to daily alcohol consumption, while in 25% no clear cause could can be identified. At least 50%-60% of all HCC patients seen have associated liver cirrhosis which can be clinically diagnosed. The presence of liver cirrhosis presents a major challenge to the treatment of hepatocellular carcinoma. Associated low platelets (thrombocytopenia), low white blood cell count (neutropenia), fluid in the patients abdomen (ascites), elevated bilirubin all must be considered when treatment is being planned. Patients who have severe confusion (encephalopathy and liver failure) are more likely to die from liver failure rather than from HCC. Thus, treatment of hepatocellular carcinoma has to take into consideration the residual functioning liver reserve.

Small HCC liver lesions may be managed by interventions such as resection, radio frequency - or cryo-ablation, alcohol ablation, or even orthotopic liver transplantation (OLT). Obviously, such interventions are limited by the size, the number, the location of tumors and the underlying liver reserve. Most importantly, none of these interventions will deal with micrometastatic disease or additional primary lesions present in the liver or outside the liver.