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Chapter 088. Hepatocellular Carcinoma (Part 6) Hepatocellular Carcinoma: Treatment Most HCC patients have two liver diseases, cirrhosis and HCC, each of which is an independent cause of death. The presence of cirrhosis usually places constraints on resection surgery, ablative therapies, and chemotherapy. Thus patient assessment and treatment planning have to take the severity of the nonmalignant liver disease into account. The clinical management choices for HCC can be complex (Fig. 88-1). The natural history of HCC is highly variable. Patients presenting with advanced tumors (vascular invasion, symptoms, extrahepatic spread) have a median survival of ~4 months, with or without treatment. Treatment. | Chapter 088. Hepatocellular Carcinoma Part 6 Hepatocellular Carcinoma Treatment Most HCC patients have two liver diseases cirrhosis and HCC each of which is an independent cause of death. The presence of cirrhosis usually places constraints on resection surgery ablative therapies and chemotherapy. Thus patient assessment and treatment planning have to take the severity of the nonmalignant liver disease into account. The clinical management choices for HCC can be complex Fig. 88-1 . The natural history of HCC is highly variable. Patients presenting with advanced tumors vascular invasion symptoms extrahepatic spread have a median survival of 4 months with or without treatment. Treatment results from the literature are difficult to interpret. Survival is not always a measure of the efficacy of therapy because of the adverse effects on survival of the underlying liver disease. A multidisciplinary team including a hepatologist interventional radiologist surgical oncologist transplant surgeon and medical oncologist is important for the comprehensive management of HCC patients. Figure 88-1 CtncMom. Thotucht Algdfithu Treatment approach to patients with hepatocellular carcinoma. The initial clinical evaluation is aimed at assessing the extent of the tumor and the underlying functional compromise of the liver by cirrhosis. Patients are classified as having resectable disease unresectable disease or as transplantation candidates. Abbreviations OLTX orthotopic liver transplantation TACE transarterial chemoembolization PEI percutaneous ethanol injection RFA radiofrequency ablation LN lymph node. Child s A B C refers to the Child-Pugh classification of liver failure. Stages I and II HCC Early-stage tumors are successfully treated using various techniques including surgical resection local ablation thermal or radiofrequency and local injection therapies ethanol or acetic acid . Because the majority of patients with HCC suffer from a field defect in the cirrhotic liver they are .
