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1 - The clinical management of hepatic neoplasms

Published online by Cambridge University Press:  23 December 2009

By
Daniel Palmer  and
Philip Johnson
Edited by
Andy Adam  and
Peter R. Mueller
Andy Adam
Affiliation:
University of London
Peter R. Mueller
Affiliation:
Massachussets General Hospital, Boston
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Summary

Introduction

The liver is the organ most frequently involved by cancer. In developing countries hepatocellular carcinoma is a major public health problem responsible for over 500 000 deaths per year. In the West its incidence is rising, in part due to the increasing prevalence of chronic hepatitis C virus infection. The liver is also the commonest site of metastases, and up to 75% of primary tumors drained by the portal venous system involve the liver before death.

This chapter will review the epidemiology, etiology, and current management of hepatocellular carcinoma and of secondary liver cancer, with particular reference to colorectal metastases as a paradigm for the multidisciplinary management of cancer.

Hepatocellular carcinoma

Epidemiology and etiology

Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide but with wide geographical variation, the highest incidence occurring in sub-Saharan Africa and the Far East. This variation suggests the importance of environmental factors (Table 1.1). Prime among these are chronic infection by hepatitis viruses B and C (HBV and HCV) and exposure to aflatoxin. In a study of 22 000 Chinese males, 15% of whom were HBV carriers, the relative risk for HCC development in HBV-positive men was 98.4. An HBV vaccination program, inoculating neonates, was initiated in Taiwan in the early 1980s and has resulted in a clear reduction in the incidence of childhood HCC. However, an effect on the incidence of HCC in adults may take a further 20 years to become apparent.

Type
Chapter
Information
Interventional Radiological Treatment of Liver Tumors , pp. 1 - 24
Publisher: Cambridge University Press
Print publication year: 2008

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