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Hepatocellular Carcinoma in the 3rd Millennium (Hardcover)
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Hepatocellular Carcinoma in the 3rd Millennium (Hardcover)
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HCC is the most common primary cancer of the liver and according to
the WHO report, the fourth commonest cause of death. The estimated
incidence of new cases worldwide is about 500,000-1,000,000 per
year causing 600,000 deaths globally per year. Although there are
large areas of the world where the incidence of HCC is still
unknown, several countries in East Asia and some Sub-Saharan
African regions are affected by a very high prevalence of HCC (over
20 cases/100,000 population). Areas with a moderately high risk
(11-20 cases/100,000 population) include Italy, Spain and Latin
America, while France, Germany and the United Kingdom have instead
an intermediate risk (5-10 cases/100,000 population). A relatively
low prevalence (less than 5 cases/100,000 population) is found in
the United States, Canada and Scandinavia. The incidence of HCC has
been rising in developed western countries in the last two decades,
along with the emergence of the hepatitis C virus infection and due
to the rise of immigration rates from HBV-endemic countries. In
addition, even though the incidence of HCC reaches its highest peak
among persons over 65 years, an increased incidence among younger
individuals has been noted in the last two decades both in USA and
Europe. A multidisciplinary approach should be taken when assessing
patients with HCC; stage of HCC and liver disease should always be
taken into account and the best treatment should be offered. Liver
resection and ablative treatments should never be denied to
patients, and curative procedures should be performed in
hepato-biliary-pancreatic centers. Each HCC patient has to be
evaluated singularly, stratifying each time the risk for the
procedure so as to determine which treatment is the best treatment.
It is also important to analyse all the possibilities that can be
offered. This similar approach showed a good efficacy and safety in
all "frail" patient categories, such as elderly patients or
patients with HCC and HIV infection. Early diagnosis of HCC and
retreatment for HCC recurrence have a key role in the survival of
patients. Therefore, regular screening programs for HCC should be
extended to all patients according to proposed guidelines, together
with a greater proclivity for treatment and retreatment options in
cases of an HCC diagnosis or recurrence. This may be an important
and needed breakthrough for this rising problem.
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