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The incidence of hepatocellular carcinoma (HCC) in America is rapidly rising. Currently, hepatocellular carcinoma represents the largest number of new liver tumor cases seen at The Methodist Hospital. The large increased in the number of hepatocellular carcinomas in our institution is due to a general increase in the number of patients with chronic hepatitis C virus infection. In addition to hepatitis C virus-related HCC cases, hepatocellular carcinomas can develop in patients with other inflammatory conditions of the liver, including chronic hepatitis B virus infection, alcoholic cirrhosis and nonalcoholic fatty liver disease.
As hepatocellular carcinoma is typically present in the setting of diffuse liver disease, it can be difficult to aggressively treat these tumors. The association between chronic liver disease and hepatocellular carcinomas is responsible for the fact that less than one quarter of patients diagnosed with hepatocellular carcinomas will ever receive oncologic treatment.
At Methodist, we are developing a comprehensive hepatocellular carcinoma treatment program for all stages of disease. The cornerstone of this program is education regarding the at-risk population of patients with longstanding inflammatory conditions of the liver. For example, we recommend that patients with chronic hepatitis C virus infection be screened every six to twelve months with liver imaging and a serum alpha-fetoprotein level.
For patients with early hepatocellular carcinomas (one tumor less than 2 cm), our efforts are focusing on local therapies and novel treatments including laparoscopic liver resection, gene therapy, radiotherapy and systemic therapy. For UNOS Stage II patients (one tumor between 2 and 5 cm or up to three tumors with none greater than 3 cm) local treatments in combination with liver transplantation offers the optimal oncologic therapy. Within the Methodist Center for Liver Disease and Transplantation these patients are evaluated with staging, detailed liver imaging, Hepatology evaluation and social support evaluation in a multidisciplinary team model. For those patients who present with more advanced disease and are not considered candidates for transplantation, we are developing a comprehensive multi-specialty treatment strategy that combines the latest innovations in local and systemic therapies.
While maintaining our excellence in patient care, within the next few months we intend to have an entire research infrastructure available to all patients with hepatocellular carcinoma. Our goal is to establish a leadership role in the development of novel and more effective treatments for this malignancy.
For patient referrals with liver masses or a hepatocellular carcinoma diagnosis, please call 1-866-94-LIVER.
Thomas A. Aloia, M.D.
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