An expert panel made up of hepatologists, oncologists and other specialists developed the recommendations based on an extensive review of relevant studies – the guidelines include more than 600 references – focusing on advances since the guidelines were last updated in 2012. Of note, the number of systemic medications for HCC has risen from just one to half a dozen.
"The rising incidence of HCC in most European countries suggests an insufficient awareness of liver disease in general, calling for public health policies aiming to prevent, detect and treat liver disease—not only for HCC prevention," the panel wrote. "It is particularly frustrating to see most patients with HCC diagnosed at a stage no longer amenable to curative treatment, demonstrating again a neglect of liver disease and appropriate cancer surveillance."
Glossaryhepatocellular carcinoma (HCC)
MORE FROM THE GLOSSARYLiver cancer is the fifth most common cancer and the second leading cause of cancer-related death, with about 854,000 new cases and 810,000 deaths per year, according to the guidelines. About 85% of all cases occur in East Asia and sub-Saharan Africa. HCC accounts for around 90% of primary liver cancers, meaning they originate in the liver. (Cancers that arise elsewhere in the body and spread to the liver are not properly considered liver cancer.)
Over years or decades, chronic hepatitis B or C virus infection, heavy alcohol consumption, fat accumulation in the liver and other causes of liver injury can lead to development of liver cirrhosis and HCC. A majority of liver cancer cases in Asia and Africa are attributable to hepatitis B, while chronic hepatitis C appears to be the major risk factor in Western countries, according to the guidelines. Non-alcoholic fatty liver disease (NAFLD) associated with metabolic syndrome, diabetes and obesity seems to be a growing cause.
Liver cancer is often detected late, when it is difficult to treat. Depending on its stage, HCC may be treated with surgery to remove part of the liver (known as resection), liver transplantation, local therapies to destroy tumours, or systemic drugs – or a combination of these. But many people experience continued disease progression or recurrence and survival is typically measured in months.
The panel made recommendations in several areas:
- Epidemiology, risk factors and prevention
- Diagnosis and recall policy
- Staging systems and treatment allocation
- Response assessment
- Liver resection
- Liver transplantation
- Local ablation and external radiation
- Transarterial therapies
- Systemic therapies
- Palliative and best supportive care. TO CONTINUE READING:http://www.infohep.org/page/3256817/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English