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Hepatocellular Carcinoma

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Key Points ��The incidence of hepatocellular carcinoma (HCC) is rising in many countries. �� ��Care of the patient with HCC involves physicians from different disciplines �� including hepatologists, surgeons, liver transplant teams, oncologists, interventional radiologists, and to some extent radiation oncologists. ����Assessing the degree of liver function impairment prior to, during and after therapy is important since HCC usually appears in the setting of underlying liver disease. Surveillance and Assessment Table 1. Groups for Whom HCC Surveillance in Recommended or in Whom the Risk of HCC is Increased, but in Whom Efficacy of Surveillance Has Not Been Demonstrated Population Group Threshold Incidence for Efficacy of Surveillance (> 0.25 LYG) (%/year) Incidence of HCC Surveillance recommended Cirrhotic hepatitis B carriers 0.2-1.5 3-8%/year Hepatitis C cirrhosis 1.5 3-5%/year Stage 4 primary biliary cirrhosis 1.5 3-5%/year Genetic hemachromatosis and cirrhosis 1.5 Unknown, but probably > 1.5%/year Alpha 1-antitrypsin deficiency and cirrhosis 1.5 Unknown, but probably > 1.5%/year Other cirrhosis 1.5 Unknown Asian male hepatitis B carriers > age 40 0.2 0.4-0.6%/year Asian female hepatitis B carriers > age 50 0.2 0.3-0.6%/year Hepatitis B carrier with family history of HCC 0.2 Incidence higher than without family history African/North American Blacks with hepatitis B 0.2 HCC occurs at a younger age Hepatitis C and stage 3 fibrosis 1.5 < 1.5%/year Non-cirrhotic NAFLD 1.5 < 1.5%/year Hepatitis B carriers < 40 (males) or < 50 (females) 0.2 < 0.2%/year Surveillance benefit uncertain

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