Early diagnosis and treatment of hepatocellular carcinoma

The incidence of hepatocellular carcinoma is increasing world-wide. Althoug h there are no randomized controlled trials showing benefits from surveilla nce programmes, these strategies have been widely practised by hepatologist s, and most early tumours are diagnosed in the setting of such a policy. In this chapter we summarize the surveillance schedule and recall the policy applied in our Unit. Diagnosis at an early stage is crucial to allow the application of curative treatments that are the only hope for increasing the life expectancy of th e patient. Surgical resection and liver transplantation are considered the first-line options for early tumours, although there is no agreement on whi ch is the best approach. Resection is limited by the high recurrence rate, whereas the increasing waiting times have decreased the intention-to-treat outcomes of transplantation. Percutaneous treatments are reserved for patie nts with single non-surgical tumours. Clinical trials assessing treatments for patients with advanced tumours have not shown any survival benefits.