SCIENCE@home

Early hepatocellular carcinoma - is there such a thing as too early?

G. McCaughan

Published 2013 in Journal of Hepatology

ABSTRACT

Small hepatocellular carcinoma (HCC) is usually detected in the setting of screening in cirrhotic patients. Although the role of screening continues to be challenged [1], it is now reasonably well accepted, and screening is now part of clinical practice [2]. Indeed, it seems now impossible to do a randomized control trial to test this. We attempted this, but with proper informed consent, we found that patients do not accept randomization into a non-screened arm [3]. The aim of screening is, of course, to detect small HCC that can be treated by local resection/ablation or liver transplantation. It is generally accepted that these therapies provide the best chance of long-term survival, although recurrence and emergence of new HCCs may impact on tumor free survival [4–6]. However, it is well known that small HCCs can remain untreated and dormant for significant periods of time [7,8]. Well differentiated HCCs with increased echogenicity on ultrasound have been described as having doubling times of >300 days [7], although small HCCs tended to have low echogenicity in a report from Japan where a number of HCCs between 1 and 2 cm in diameter did not change size over a 10–20 month period [8]. Thus questions have always existed – how small is small? How small can you go with just observation without intervention? The manuscript by Midorikawa et al., attempts to answer these questions with interesting results and challenging conclusions [9]. EASL and AASLD guidelines define the smallest HCC as simply very early stage HCC (<2 cm) [4,5]. It is recommended that lesions <1 cm should be observed. If the lesion is between 1–2 cm without the characteristic findings of arterial hyper vascularity and venous or delayed phase washout on 4 phase CT scan or contrast enhanced MRI, then biopsy is recommended. APASL guidelines do not recommend biopsy but recommend a series of additional imaging techniques aimed at detection of Kupffer cell uptake [6,10]. Once HCC is diagnosed, all 3 guidelines recommend local therapies (ablation, resection or transplantation). Japanese investigators have studied small or early HCC for some time [9,11,12]. There is also a recent international consensus report on the pathology of such lesions [13]. Midorikawa

PUBLICATION RECORD

CITATION MAP

EXTRACTION MAP

CLAIMS

  • No claims are published for this paper.

CONCEPTS

  • No concepts are published for this paper.

REFERENCES

Showing 1-17 of 17 references · Page 1 of 1

CITED BY