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Medical Therapy of Hepatocellular Carcinoma

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Hepatocellular Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

The principles underlying medical management of hepatocellular carcinoma (HCC) are based on an understanding of the clinical setting, the tumor characteristics, and the underlying biology. Reviewing our patient population, we found that 81% had cirrhosis and 19% had no evidence of cirrhosis by biopsy or computed tomography (CT) scan (Table 1). The male/female ratio was 2.5:1, and 72% of our patients were caucasian. Interestingly, 24% of our patients had no symptoms at all but were diagnosed either by the finding of elevated liver function test results on routine physical examination or as an incidental finding, such as a work-up for some unrelated disease. A further 17% of patients were diagnosed because of a planned surveillance CT scan screening because of a known history of hepatitis B or C, cirrhosis, or both. Eighteen percent of patients had the symptoms of cirrhosis, which include ankle swelling, abdominal bloating, increased girth, pruritus, encephalopathy, or a gastrointestinal (GI) bleed, and a full 40% of patients had abdominal pain at presentation. This seemed to be the most common presenting symptom in our patient population. We also found a significant proportion of our patients had experienced weight loss, general malaise or weakness, and loss of appetite. We recently found (unpublished data) that more than 80% of patients report loss of sexual function or desire within the proceeding 12 months of the diagnosis. This seems to be a sensitive but nonspecific correlate of our cancer patients and was found on analysis of our systematic study of quality-of-life questionnaires. The tumor characteristics tend to display interesting patterns. In our experience, HCC is typically a multifocal and bilobar cancer (Table 1, tumor characteristics), and is thus typically not a surgeon’s disease. In addition, portal vein invasion of either the main portal or main branch portal vein, as judged by occlusion of flow or expansion of the vein on CT scan, occurred in 75% of our patients (Table 2).

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  1. Liver Cancer Center, Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

    Brian I. Carr MD, FRCP, PhD

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  1. Brian I. Carr MD, FRCP, PhD
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  1. Liver Cancer Center, Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

    Brian I. Carr MD, FRCP, PhD

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© 2005 Humana Press Inc., Totowa, NJ

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Carr, B.I. (2005). Medical Therapy of Hepatocellular Carcinoma. In: Carr, B.I. (eds) Hepatocellular Cancer. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-59259-844-1_12

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  • DOI: https://doi.org/10.1007/978-1-59259-844-1_12

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-125-7

  • Online ISBN: 978-1-59259-844-1

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