Alpha-fetoprotein (AFP) levels in the blood can be used to monitor for progression of hepatocellular carcinoma. It can also be used to monitor for recurrence of disease.
On ultrasound, HCC has variable echogenicity. Vascular invasion can be visualized along with the tumor. Cirrhosis of the liver as a secondary finding is often seen.
CT or MRI of the abdomen can be used to visualize tumor margins better. It can also be used for staging e.g. local invasion, portal vein involvement, or metastasis.
Surgical resection is a potentially curative therapy indicated in patients without vascular invasion, metastases, or impaired liver function.
Liver transplantation is another possible treatment. Depending on the availability of donor organs, a waiting period of 6-18 months can be expected. For this reason, patients are treated with ablative methods until they are transplanted to prevent tumor growth or to reduce the size of the tumor. This is also known as “downsizing”.
Some image-guided procedures via interventional radiology can be conducted to either down-size or potentially as a primary treatment option for appropriately selected candidates. Procedures like transarterial chemoembolization (TACE) and radioembolization (TARE) involve the use of catheters to deliver targeted therapy directly to the tumor thus minimizing wide parenchymal effects.
HCC surveillance aims to detect the disease in an early stage and to catch it while it is still resectable. A combination of ultrasound and AFP is recommended.
Since most HCCs are often discovered late and the underlying cirrhosis of the liver limits the therapeutic options, treatment of the disease is still difficult and the prognosis is unfavorable.
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