Description
This webinar focuses on the comprehensive management of hepatocellular carcinoma using current evidence-based guidelines. It will cover risk stratification, surveillance strategies, and diagnostic approaches for early detection. Participants will gain insights into treatment options including locoregional therapies, systemic treatments, and surgical interventions. Multidisciplinary decision-making and patient selection will be emphasized. Updates on emerging therapies and clinical trial data will be discussed to improve patient outcomes.
Summary Listen
- Hepatocellular carcinoma (HCC) poses a significant challenge due to its increasing incidence and late-stage diagnosis in many patients. A key difficulty in treating HCC is the frequent presence of underlying liver cirrhosis, complicating treatment strategies.
- The liver, divided into eight segments, is often affected by HCC in the context of chronic liver disease. The progression from chronic hepatitis to cirrhosis and ultimately HCC highlights the importance of understanding the etiological factors like hepatitis B and C, alcohol, and metabolic disorders.
- Diagnosis involves clinical presentation and protocol-based investigations, with imaging playing a crucial role. Ultrasound, CT scans, and MRIs are used to identify lesions, while biopsies are rarely necessary if imaging criteria are met. Regular follow-up is essential for lesions smaller than 1 cm.
- Staging HCC is complex and controversial, involving various classification systems like Okuda, CLIP, and BCLC. The BCLC staging system, while widely used, has limitations, leading to the development of modified classifications like BCLC 22 and the Hong Kong Liver Cancer classification. There is no globally accepted staging system, making treatment decisions challenging.
- Bridging and downstaging therapies are essential for patients awaiting liver transplantation. These therapies, including local ablation techniques like radiofrequency ablation and microwave ablation, aim to control tumor growth and prevent metastasis.
- Liver transplantation offers a potentially curative option for HCC, particularly in patients meeting Milan criteria. Meld exception scores prioritize HCC patients on transplant lists. However, high AFP levels (>1000) may contraindicate transplantation due to increased recurrence risk.
- Local ablation therapies like radiofrequency ablation (RFA) and microwave ablation (MWA) are used for bridging and downstaging. MWA is increasingly favored over RFA due to its larger ablation volumes and reduced heat sink effect. Transarterial chemoembolization (TACE) is another option, but is contraindicated in cases of portal vein thrombosis.
- Selective internal radiation therapy (SIRT), also known as TARE, utilizes microspheres to deliver targeted radiation. It is an option, especially in cases with portal vein thrombosis, where TACE is contraindicated.
- Surgical resection is the preferred treatment in the absence of cirrhosis and in patients with adequate future liver remnant (FLR). Achieving an R0 resection with a clear margin is crucial, but wide margins are not necessarily beneficial.
- Laparoscopic liver resection is becoming increasingly common for accessible tumors. Post-operative monitoring for complications like hemorrhage and liver failure is vital. The 50-50 criteria (bilirubin >3 and PT >1.7 on post-operative day 5) can indicate post-hepatectomy liver failure.
- Adjuvant therapies after resection lack standardization. Liver transplantation remains a valuable option for HCC patients with decompensated liver disease.
Sample Certificate
About the Speakers
Dr. Rohith Mudadla
Consultant Gastroenterologist, GITAM Institute of Medical Sciences and Research, Vishakhapatnam
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