Diagnosis, staging and treatment of hepatocellular carcinoma

Abstract

Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies. Correspondence

Role of Diffusion Weighted Imaging (DWI) for Hepatocellular Carcinoma (HCC) Detection and its Grading on 3T MRI: A Prospective Study

“…The radiological criteria have been proposed for diagnosing HCC early without sampling. 11 The diagnostic imaging criteria for HCC include arterial phase enhancement with washout in the portal venous and/or delayed phases on computed tomography or magnetic resonance imaging. 12,13 However, gadolinium contrast cannot be used in patients with chronic renal failure due to risk of nephrogenic systemic fibrosis and in those with history of allergy to gadolinium.…”

Percutaneous Local Injection of Ethanol and Mitoxantrone in Treatment of Hepatocellular Carcinoma

“…Local ablation therapy for HCC is associated with a variety of complications as shown in table (2). The most frequent complication was tolerable pain while intolerable pain (needs analgesics) detected in 27.6% and 20% of patients in group I and group II respectively.…”

“…Ethanol induces immediate coagulative necrosis and injury then thrombosis of tumor cells and enable the complete ablation of small neoplastic lesions without adversely affecting liver function.PEI is a procedure of easy execution, good tolerability and low cost, which can be applied in repeated sessions [2] and that is why we used this maneuver for percutanous ablation in our low resource community. PEI performed under ultrasonographic guidance achieves complete tumor necrosis in 70%-80% of solitary HCC ≤ 3cm [11] and in almost 100% in tumors less than 2 cm.…”

“…Ultasound, CT, Triphasic CT and MRI are used in diagnosis of these tumors [2]. Surgical resection, liver transplantation and cryosurgery are considered the best curative options for HCC.…”

“…Ablation of liver tumors is currently the main alternative to formal liver resection [5]. Percutaneous ethanol injection (PEI) is a procedure of easy execution, good tolerability and low cost, which can be applied in repeated sessions [2].…”