eMedicine Specialties > Oncology > Carcinomas of the Gastrointestinal Tract

Hepatic Carcinoma, Primary: Follow-up

Author: Keith E Stuart, MD, Chairman, Department of Hematology and Oncology, Lahey Clinic
Coauthor(s): Zsofia K Stadler, MD, Clinical Fellow, Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School
Contributor Information and Disclosures

Updated: Jan 12, 2009

Follow-up

Further Outpatient Care

Monitor the progression of disease or adequacy of treatment with imaging studies every 2-3 months and LFTs and AFP monthly or as appropriate for the stage of disease and patient's performance status. These interventions, however, have little or no impact on prognosis for survival and therefore should be performed in accordance with the patient's functional status.

Deterrence/Prevention

Patients should avoid alcohol and other hepatic toxins because prognosis is related to worsening cirrhosis and tumor stage.

Complications

Symptoms of hepatic failure may signify tumor recurrence and/or progression.

Prognosis

Overall prognosis for survival depends on the extent of cirrhosis and tumor stage, which then determine the appropriate treatment. Patients able to undergo a curative resection have a median survival of as long as 4 years; patients who present when they are too ill to be treated have a median survival of 3 months.40

Patient Education

For excellent patient education resources, visit eMedicine's Hepatitis Center and Liver, Gallbladder, and Pancreas Center. Also, see eMedicine's patient education articles, Cirrhosis, Hepatitis B, Hepatitis C, and Liver Transplant.

Miscellaneous

Medicolegal Pitfalls

  • Consider hepatocellular carcinoma in any person with possible risk factors who develops symptoms of liver disease, such as unexplained jaundice, increased abdominal girth, or pruritus.
  • Family members of patients with hepatitis B infections should undergo screening for the virus.
  • Consider screening of patients with cirrhosis, especially those with hepatitis C infection.

Special Concerns

  • Screening for hepatocellular carcinoma
    • Despite the widespread use of screening and surveillance programs for hepatocellular carcinoma, the efficacy and cost-effectiveness of screening programs for at-risk patients is unclear.41
    • In general, the annual incidence of developing hepatocellular carcinoma in the setting of cirrhosis is approximately 1-4%. Screening studies have shown that, although lesions may be discovered at an earlier stage, the lack of curative treatment options in patients with cirrhosis may not lead to improvements in survival.
    • Patients with chronic hepatitis B without cirrhosis have a much lower annual incidence of developing hepatocellular carcinoma of 0.46%. The incidence of hepatocellular carcinoma in patients with chronic hepatitis C without cirrhosis is even lower. Screening programs using AFP and an imaging modality in patients with hepatitis B or C without cirrhosis is not cost-effective given the low incidence of hepatocellular carcinoma in these patients and the high cost of imaging techniques.
    • Survival advantage with screening in these at-risk populations has not been demonstrated. The retrospective screening studies that have shown modest survival advantages are confounded by lead-time and length-time bias.
    • If screening is to be undertaken, AFP should not be used alone as a screening test. Instead, AFP should be combined with an imaging modality (ultrasonography, CT scan) to improve sensitivity and specificity.
 


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Treatment & Medication: Hepatic Carcinoma, Primary
Follow-up: Hepatic Carcinoma, Primary
Multimedia: Hepatic Carcinoma, Primary
References
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Further Reading

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Keywords

primary hepatocellular carcinoma, HCC, liver cancer, primary liver cancer, liver carcinoma, primary liver carcinoma, cirrhosis, liver failure, hepatoma, liver dysfunction, hepatic dysfunction, liver tumor, hepatic tumor, liver disease, jaundice, hepatitis B virus, HBV, hepatitis C virus, HCV, hepatitis virus, alcoholism, alcoholic liver disease, hemochromatosis, aflatoxin, liver function test, liver function testing, LFTs, OLT, orthotopic liver transplantation, liver transplantation, liver transplant

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Contributor Information and Disclosures

Author

Keith E Stuart, MD, Chairman, Department of Hematology and Oncology, Lahey Clinic
Disclosure: Nothing to disclose.

Coauthor(s)

Zsofia K Stadler, MD, Clinical Fellow, Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School
Disclosure: Nothing to disclose.

Medical Editor

Antoni Ribas, MD, Department of Medicine, Division of Hematology-Oncology, Assistant Professor of Medicine, University of California at Los Angeles Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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