Chapter 80 Ghassan K. Abou-Alfa, William Jarnagin, Maeve Lowery, Michael D’Angelica, Karen Brown, Emmy Ludwig, Anne Covey, Nancy Kemeny, Karyn A. Goodman, Jinru Shia and Eileen M. O’Reilly • 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 etiology. • The majority of biliary tumors are adenocarcinomas. • Despite their similarities, biliary tumors are now better understood as three different diseases: gallbladder cancer, extrahepatic, and intrahepatic biliary tumors, 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 tumor control and staging. • Preoperative considerations for extrahepatic biliary tumors 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 tumors. • The standard of care for advanced disease consists of gemcitabine plus cisplatin based on the ABC-02 study.
Liver and Bile Duct Cancer
Summary of Key Points
Liver Cancer
Biliary Tumors
