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Multi-disciplinary Approach to HCC
The treatment of hepatocellular carcinoma (HCC) is quite challenging and requires
a multi-disciplinary approach. A recent review of patients with HCC indicated that,
of the population at risk for HCC, 23.9% were due to hepatitis C virus (HCV), approximately
10% were due to hepatitis B virus (HBV), and approximately 41% related to daily
alcohol consumption, while in 25% no clear cause could can be identified. At least
50%-60% of all HCC patients seen have associated liver cirrhosis which can be clinically
diagnosed. The presence of liver cirrhosis presents a major challenge to the treatment
of hepatocellular carcinoma. Associated low platelets (thrombocytopenia), low white
blood cell count (neutropenia), fluid in the patients abdomen (ascites), elevated
bilirubin all must be considered when treatment is being planned. Patients who have
severe confusion (encephalopathy and liver failure) are more likely to die from
liver failure rather than from HCC. Thus, treatment of hepatocellular carcinoma
has to take into consideration the residual functioning liver reserve.
Small HCC liver lesions may be managed by interventions such as resection, radio
frequency - or cryo-ablation, alcohol ablation, or even orthotopic liver transplantation
(OLT). Obviously, such interventions are limited by the size, the number, the location
of tumors and the underlying liver reserve. Most importantly, none of these interventions
will deal with micrometastatic disease or additional primary lesions present in
the liver or outside the liver.
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