Hepatocellular carcinoma: screening and non-surgical treatment

Abstract

Hepatocellular carcinoma (HCC) is the second commonest cancer in Hong Kong. Recent advances show that HCC can be derived from hepatocytes and from progenitor oval cells. Those from progenitor oval cells express both hepatocyte and biliary markers and are associated with poorer differentiation, more cellular proliferation, more aggressive clinical course and poorer prognosis. Patients with HCC usually present late and the choice of treatment modalities will be limited. Screening for early subclinical HCC in high-risk groups is indicated. In patients diagnosed by screening, the clinical parameters were significantly more favourable, with a higher resectability rate, a higher chance of responding to transarterial chemoembolization (TACE) and a better survival. Treatment for HCC at present is still not satisfactory because of the late presentation, low resection rate, the high recurrence/new occurrence rate and the high prevalence of background cirrhosis. Surgical resection remains the first choice of treatment. However, there is a high recurrence rate. Medical treatment for inoperable HCC can be divided into systemic and local/regional therapy. To date, there are relatively few randomized controlled trials. Systemic therapy consists of the use of doxorubicin, alpha-interferon, tamoxifen or combination therapy. For the local/regional therapy, alcohol injection and TACE with lipiodol are the two commonly used methods. Selective intra-arterial infusion of 90yttrium has also been described. Randomized controlled trials are urgently needed to assess the efficacy of various medical treatments.