Surveillance and Assessment Role of AFP in Diagnosis
ÎAlphafetoprotein (AFP) has long been used for the diagnosis of HCC. However, it is insufficiently sensitive or specific for use as a surveillance assay.
ÎRecent 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.
ÎThe diagnosis of HCC must rest on radiological appearances and on histology.
ÎLikewise, the monitoring of AFP levels after therapy does not replace imaging.
Selecting a Treatment Regimen
ÎPatients 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).
ÎLiver 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).
ÎLocal ablation is safe and effective therapy for patients who cannot undergo resection, or as a bridge to transplantation (II).
