Worldwide, hepatocellular carcinoma (HCC) is responsible for at least 1 million deaths a year. It is almost always associated with chronic underlying liver disease, specifically hepatitis B, C, and in the western industrial nations with alcohol-induced cirrhosis. The definition of these and other less common risk factors presents both an opportunity and a difficulty: the opportunity to prevent and/or screen a high-risk population for the development of HCC, but the difficulty of treating patients with chronic liver dysfunction. The only potential curative therapy is surgery, though it is curative in only a small percentage. Surgical innovations such as cryosurgery and percutaneous alcohol injection have not yet been shown to offer any advantage, and liver transplantation, while curative in some patients, requires an enormous expenditure of resources to achieve cure in few patients. There are numerous palliative treatment options in patients with more advanced disease, however, differences in patient selection and the lack of randomized studies make their impact on median survival difficult to assess. Conventional chemotherapy is clearly ineffective in HCC. Modifications of chemotherapy, including intraarterial infusion and chemoembolization, tamoxifen, other hormonal agents, interferon, as well as radioimmunotherapy, and conformal radiotherapy have not been shown to offer any therapeutic benefit until today. Patients being treated for HCC should thus be enrolled on treatment protocols evaluating multimodality or new strategies.

Keywords:
Hepatocellular carcinoma, –diagnosis, –staging, –treatment, Hepatectomy, Liver transplantation, Cryosurgery, Percutaneous alcohol injection, Chemotherapy, intraarterial, Chemoembolization
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© 1995 S. Karger AG, Basel
1995
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