Key Points ÎThe incidence of hepatocellular carcinoma (HCC) is rising in many countries.
ÎCare 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.
ÎAssessing 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
Surveillance recommended Cirrhotic hepatitis B carriers Hepatitis C cirrhosis
Stage 4 primary biliary cirrhosis
Genetic hemachromatosis and cirrhosis
Alpha 1-antitrypsin deficiency and cirrhosis
Other cirrhosis
Asian male hepatitis B carriers > age 40
Asian female hepatitis B carriers > age 50
Hepatitis B carrier with family history of HCC
African/North American Blacks with hepatitis B
Surveillance benefit uncertain Hepatitis C and stage 3 fibrosis Non-cirrhotic NAFLD
Hepatitis B carriers < 40 (males) or < 50 (females)
Threshold Incidence for Efficacy of Surveillance (> 0.25 LYG) (%/year)
0.2-1.5 1.5 1.5 1.5
1.5
1.5 0.2
0.2 0.2 0.2
1.5 1.5 0.2
Incidence of HCC
3-8%/year 3-5%/year 3-5%/year
Unknown, but probably > 1.5%/year
Unknown, but probably > 1.5%/year
Unknown 0.4-0.6%/year 0.3-0.6%/year
Incidence higher than without family history
HCC occurs at a younger age
< 1.5%/year < 1.5%/year < 0.2%/year
