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Hepatocellular carcinoma (HCC) used to be regarded as a rare disease.
The increasing numbers of chronic hepatitis C virus carriers in the United
States and subsequent increased incidence of HCC seen in most large
medical centers means that it is no longer an uncommon disease for most
gastroenterologists or oncologists to encounter.
During the times when liver resection or systemic chemotherapy were
the only real therapeutic modalities available, the outcomes were generally
dismal, especially because most patients presented with advanced-stage
tumors. Several recent factors seem to have changed this. They include the
more frequent use of aggressive surveillance by ultrasound and computed
tomography (CT) scanning in patients who have chronic hepatitis or
cirrhosis from any cause (and thus are known to be at risk for subsequent
development of HCC) to detect tumors at an earlier and therefore more
treatable stage. Advances in CT scanning, particularly the introduction of
multihead fast helical scans, mean that this vascular tumor can often be
detected at an earlier stage, or multiple lesions can be diagnosed when only
large single lesions were formerly seen, so that unnecessary resections are
not performed.
Liver transplantation has had a profound effect on the therapeutic landscape.
There have always been two hopes for this modality: namely, to
eliminate cirrhosis as a limiting factor for surgical resection and also
to extend the ability of the surgeon to remove ever-larger tumors confined
to the liver. Regional chemotherapy and hepatic artery chemoembolization
have been around for a long time and have been practiced mainly in the Far
East and Europe.
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