Liver cancer: Surveillance & Treatments
Liver cancer surveillance in chronic hepatitis B
Hepatitis C, hepatitis B, alcoholic liver disease and primary biliary cirrhosis are the risk factors for liver cirrhosis and liver cancer. Liver cirrhosis is progressing in 5 to 30% of the patients who have progressed to liver cancer for 5 years. Therefore, people with high risk of hepatocellular carcinoma like this one need surveillance. The method is liver ultrasound and AFP. Liver ultrasound has 60% sensitivity and 90% specificity. AFP of 20 ng / ml or more is suspicious for liver cancer, but the sensitivity is about 20 to 60%. The interval between surveillance is 6 to 12 months.
Treatment
There are three ways to cure primary liver cancer. First, partial hepatectomy is the best treatment or only 10 to 30% of patients are operable. Most of the contraindication is cirrhosis. This method proceeds after judging whether the residual liver function is appropriate. In Korea, Child Pugh B is also considered. It is usually done when the cancer is less than 6 cm and the prognosis is better than the TACE if it is large. Postoperative adjuvant CTx and neoadjuvant CTx have no definite efficacy, and most of the deaths due to complications of liver cirrhosis are associated with cancer rather than death. The second method is liver transplantation. The indication for liver transplantation is when it meets Milan criteria. It is a single tumor less than 5 cm, multiple (but not more than 3) tumors less than 3 cm in length and free of distant metastasis or angiotension. Prognosis is better than partial hepatic resection. The third method is topical treatment. These include radio-frequency ablation, percutaneous ethanol injection, and cryoablation. The most commonly used RFA is an average of 1 to 2 treatments, with less than 3 small tumors (<3 cm) with good surgical outcomes with similar surgical resection and 5-year survival rates. Single tumors can be RFA up to 5 cm, but more than 5 cm should be operated. Uncontrolled hepatic coma, ascites, clotting disorders, and systemic bacterial infections are contraindications to RFA. In patients who are unable to undergo surgery or local ablation therapy, the survival rate increases with carotid embolization (TACE).
Hepatitis C, hepatitis B, alcoholic liver disease and primary biliary cirrhosis are the risk factors for liver cirrhosis and liver cancer. Liver cirrhosis is progressing in 5 to 30% of the patients who have progressed to liver cancer for 5 years. Therefore, people with high risk of hepatocellular carcinoma like this one need surveillance. The method is liver ultrasound and AFP. Liver ultrasound has 60% sensitivity and 90% specificity. AFP of 20 ng / ml or more is suspicious for liver cancer, but the sensitivity is about 20 to 60%. The interval between surveillance is 6 to 12 months.
Treatment
There are three ways to cure primary liver cancer. First, partial hepatectomy is the best treatment or only 10 to 30% of patients are operable. Most of the contraindication is cirrhosis. This method proceeds after judging whether the residual liver function is appropriate. In Korea, Child Pugh B is also considered. It is usually done when the cancer is less than 6 cm and the prognosis is better than the TACE if it is large. Postoperative adjuvant CTx and neoadjuvant CTx have no definite efficacy, and most of the deaths due to complications of liver cirrhosis are associated with cancer rather than death. The second method is liver transplantation. The indication for liver transplantation is when it meets Milan criteria. It is a single tumor less than 5 cm, multiple (but not more than 3) tumors less than 3 cm in length and free of distant metastasis or angiotension. Prognosis is better than partial hepatic resection. The third method is topical treatment. These include radio-frequency ablation, percutaneous ethanol injection, and cryoablation. The most commonly used RFA is an average of 1 to 2 treatments, with less than 3 small tumors (<3 cm) with good surgical outcomes with similar surgical resection and 5-year survival rates. Single tumors can be RFA up to 5 cm, but more than 5 cm should be operated. Uncontrolled hepatic coma, ascites, clotting disorders, and systemic bacterial infections are contraindications to RFA. In patients who are unable to undergo surgery or local ablation therapy, the survival rate increases with carotid embolization (TACE).
