Multidisciplinary Care of the Hepatocellular Carcinoma Patient

  • Carlo M. Contreras
  • Jean-Nicolas Vauthey
  • Kelly M. McMasters


Hepatocellular carcinoma (HCC) is a complex disease that requires the attention of physicians and surgeons from diverse backgrounds. This chapter will focus on the unique contributions of the hepatologist, radiologist, pathologist, medical oncologist, interventional radiologist, transplant surgeon, and the hepatobiliary surgeon. This chapter will conclude by illustrating how careful multidisciplinary care optimizes the long-term outcomes of patients with HCC.


HCC care Hepatocellular carcinoma Multidisciplinary care HCC treatment 


  1. 1.
    Zeuzem S, Feinman SV, Rasenack J et al (2000) Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med 343:1666–1672Google Scholar
  2. 2.
    Chronic Hepatitis C: Current Disease Management Hepatitis, vol. (2009) Bethesda: National Digestive Diseases Information Clearinghouse, 2006: NIH Publication No. 07–4230.Google Scholar
  3. 3.
    Dienstag JL (2008) Drug therapy: hepatitis B virus infection. N Engl J Med 359:1486–1500CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang BH, Yang BH, Tang ZY (2004) Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 130:417–22Google Scholar
  5. 5.
    Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236CrossRefPubMedGoogle Scholar
  6. 6.
    Poon RTP, Fan ST (2003) Evaluation of the new AJCC/UICC staging system for hepatocellular carcinoma after hepatic resection in Chinese patients. Surg Oncol Clin N Am 12:35–50CrossRefPubMedGoogle Scholar
  7. 7.
    Ramacciato G, Mercantini P, Cautero N et al (2005) Prognostic evaluation of the new American joint committee on cancer/international union against cancer staging system for hepatocellular carcinoma: Analysis of 112 cirrhotic patients resected for hepatocellular carcinoma. Ann Surg Oncol 12:289–297CrossRefPubMedGoogle Scholar
  8. 8.
    Varotti G, Ramacciato G, Ercolani G et al (2005) Comparison between the fifth and sixth editions of the AJCC/UICC TNM staging systems for hepatocellular carcinoma: Multicentric study on 393 cirrhotic resected patients. Eur J Surg Oncol 31:760–767CrossRefPubMedGoogle Scholar
  9. 9.
    Wu CC, Cheng SB, Ho WM et al (2005) Liver resection for hepatocellular carcinoma in patients with cirrhosis. Br J Surg 92:348–355CrossRefPubMedGoogle Scholar
  10. 10.
    Lei HJ, Chau GY, Lui WY et al (2006) Prognostic value and clinical relevance of the 6th Edition 2002 American Joint Committee on Cancer staging system in patients with resectable hepatocellular carcinoma. J Am Coll Surg 203:426–435CrossRefPubMedGoogle Scholar
  11. 11.
    Kee KM, Wang JH, Lee CM et al (2007) Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: analysis of 5,613 cases from a medical center in southern Taiwan. Int J Cancer 120:2650–2655Google Scholar
  12. 12.
    Vauthey JN, Ribero D, Abdalla EK et al (2007) Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma: validation of a uniform staging after surgical treatment. J Am Coll Surg 204:1016–1027CrossRefPubMedGoogle Scholar
  13. 13.
    Pomfret EA, Washburn K, Wald C et al (2010) Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl 16:262–278Google Scholar
  14. 14.
    Ariff B, Lloyd CR, Khan S et al (2009) Imaging of liver cancer. World J Gastroenterol 15:1289–1300Google Scholar
  15. 15.
    Ribero D, Abdalla EK, Madoff DC et al (2007) Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 94:1386–1394CrossRefPubMedGoogle Scholar
  16. 16.
    Llovet JM, Chen Y, Wurmbach E et al (2006) A molecular signature to discriminate dysplastic nodules from early hepatocellular carcinoma in HCV cirrhosis. Gastroenterology 131:1758–1767CrossRefPubMedGoogle Scholar
  17. 17.
    Wurmbach E, Chen Y-B, Khitrov G et al (2007) Genome-wide molecular profiles of HCV-induced dysplasia and hepatocellular carcinoma. Hepatology 45:938–947CrossRefPubMedGoogle Scholar
  18. 18.
    Vauthey JN, Lauwers GY, Esnaola NF et al (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20:1527–1536CrossRefPubMedGoogle Scholar
  19. 19.
    Hoshida Y, Villanueva A, Kobayashi M et al (2008) Gene expression in fixed tissues and outcome in hepatocellular carcinoma. N Engl J Med 359:1995–2004Google Scholar
  20. 20.
    Vauthey JN, Klimstra D, Franceschi D et al (1995) Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg 169:28–34CrossRefPubMedGoogle Scholar
  21. 21.
    Yeo W, Mok TS, Zee B et al (2005) A randomized phase III study of doxorubicin versus cisplatin/interferon {alpha}-2b/doxorubicin/fluorouracil (PIAF) combination chemotherapy for unresectable hepatocellular carcinoma. J Natl Cancer Inst 97:1532–1538CrossRefPubMedGoogle Scholar
  22. 22.
    Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390Google Scholar
  23. 23.
    Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):S20–S37CrossRefPubMedGoogle Scholar
  24. 24.
    Kishi Y, Madoff DC, Abdalla EK et al (2008) Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 144:744–751CrossRefPubMedGoogle Scholar
  25. 25.
    Palavecino M, Chun YS, Madoff DC et al (2009) Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: perioperative outcome and survival. Surgery 145:399–405CrossRefPubMedGoogle Scholar
  26. 26.
    Lencioni R, Cioni D (2007) Percutaneous methods for ablation of hepatic neoplasms. In: Blumgart L (ed) Surgery of the Liver, Biliary Tract, and Pancreas, 4th edn. Elsevier, New York, pp 1269–1277Google Scholar
  27. 27.
    Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442CrossRefPubMedGoogle Scholar
  28. 28.
    Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699Google Scholar
  29. 29.
    Yao FY, Ferrell L, Bass NM et al (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33:1394–403Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Carlo M. Contreras
    • 1
  • Jean-Nicolas Vauthey
    • 2
  • Kelly M. McMasters
    • 3
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of SurgeryUniversity of LouisvilleLouisvilleUSA

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