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Liver-directed therapies for hepatocellular cancer
1 University of Mississippi and Jackson VAMC, Jackson, MS, and 2 Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
Although hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, it is relatively rare in the United States, with a significant rise in incidence over the past 2–3 decades. It usually develops in patients with chronic viral hepatitis or excessive alcohol use who develop cirrhosis of the liver. Surgical resection is the only curative treatment for HCC. Partial hepatectomy is an ideal treatment option for patients with small tumors (< 5 cm), Child-Pugh class A disease, and no evidence of portal hypertension. Liver transplantation must be considered in patients who meet the Milan criteria, since it can potentially cure both HCC and the underlying cirrhosis. Unfortunately, most patients with HCC present with advanced disease and/or major comorbidities and therefore have limited treatment options. The choice of palliative therapy depends on the performance status, comorbidities, and degree of liver dysfunction. Local ablative therapies, such as ethanol injection, radiofrequency ablation (RFA), and cryoablation, may be used as alternatives to surgery in nonresectable patients. In patients with multiple, large, unresectable HCC, transarterial chemoembolization can also be used. At present, there is no effective systemic treatment for HCC. Evolving targeted therapies for HCC would hopefully bring more effective options in the near future.
| Commun Oncol 2007;4:571–574, 576 | full text |  164 kb |