Surveillance and Assessment
Role of AFP in Diagnosis
����Alphafetoprotein (AFP) has long been used for the diagnosis
of HCC. However, it is insufficiently sensitive or specific for
use as a surveillance assay.
����Recent data also suggest that its use as a diagnostic test is
less specific than was once thought. AFP can be elevated in
intrahepatic cholangiocarcinoma and in some metastases
from colon cancer.
����The diagnosis of HCC must rest on radiological appearances
and on histology.
����Likewise, the monitoring of AFP levels after therapy does not
replace imaging.
Selecting a Treatment Regimen
����Patients who have a single lesion can be offered surgical
resection if they are non-cirrhotic or have cirrhosis but still
have well preserved liver function, normal bilirubin and
hepatic vein pressure gradient < 10 mmHg (II).
>> Pre or post-resection adjuvant therapy is NOT recommended (II).
����Liver transplantation is an effective option for patients with
HCC corresponding to the Milan criteria: < 5 cm for a single
lesion, or multiple lesions involving no more than 3 lesions
with the largest measuring ��� 3 cm (II).
������ Living donor transplantation can be offered for HCC if the waiting time is
expected to be so long that there is a high risk of tumor progression leading to
exclusion from the waiting list (II).
������ No recommendation can be made regarding expanding the listing criteria
beyond the standard Milan Criteria (III).
������ Preoperative therapy can be considered if the waiting list exceeds 6 months (II).
����Local ablation is safe and effective therapy for patients who
cannot undergo resection, or as a bridge to transplantation (II).
