LIVER AND BILE DUCT CANCER OVERVIEW
- There is a continued rise of hepatocellular carcinoma (HCC) incidence especially in the Western hemisphere.
- HCC main risk factors are hepatitis B, hepatitis C, alcohol, and nonalcoholic steatohepatitis.
- Screening programs continue to evolve, but depend mainly on ultrasound and α-fetoprotein (AFP) evaluations.
- Staging of HCC depends on evaluating the two aspects of the disease: the cancer itself, and the commonly associated cirrhosis.
- Pathology evaluation may help distinguish variants or combined HCC and cholangiocarcinoma.
- Patterns of spread are hematogenous, and may involve lung and bones.
- Surgery, liver transplantation, and radiofrequency ablation (RFA), are the sole proven curative therapies for HCC.
- Locally advanced disease is generally treated with different forms of local therapies, including but not limited to, transarterial chemoembolization, bland embolization, radioembolization, and radiation therapy.
- Sorafenib is the sole drug approved for the treatment of advanced HCC, based on an improvement in survival compared with placebo.
- Future developments are likely to be dependent on the evaluation of combination therapies and/or the development of new targets.
- Future studies are most likely to entail enriched patient populations based on biology, risk factors, and/or aetiology.
- The majority of biliary tumours are adenocarcinomas.
- Despite their similarities, biliary tumours are now better understood as three different diseases: gallbladder cancer, extrahepatic, and intrahepatic biliary tumours, with different clinical and biological characteristics.
- Gallbladder resection may require resection of segments IVA and V of the liver plus a locoregional lymph node dissection for better tumour control and staging.
- Preoperative considerations for extrahepatic biliary tumours include percutaneous transhepatic biliary drainage.
- Surgical therapy for distal extrahepatic cholangiocarcinoma is a pancreaticoduodenectomy, as for all periampullary malignancies.
- No adjuvant therapy has been proven effective for biliary tumours.
- The standard of care for advanced disease consists of gemcitabine plus cisplatin based on the ABC-02 study.
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