Hepatocellular Carcinoma Diagnosis and Treatment
Hepatocellular cancer is the the fifth most common cancer, with 600,000 new cases reported each year worldwide. Additionally, exciting changes in the science of HCC in the last four years have turned the practice of diagnosing and treating the disease ups
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CURRENT CLINICAL ONCOLOGY Maurie Markman, MD, SERIES EDITOR
For other titles published in this series, go to http://www.springer.com/series/7631
HEPATOCELLULAR CARCINOMA Diagnosis and Treatment Second Edition
Edited by
BRIAN I. CARR, MD, FRCP, PhD Professor of Medicine, Kimmel Cancer Center Thomas Jefferson University, Philadelphia, PA, USA
Editor Brian I. Carr, MD, FRCP, PhD Kimmel Cancer Center Thomas Jefferson University Bluemle Building Room 519 233 S. 10th Street Philadelphia, PA 19107 USA [email protected]
ISBN 978-1-60327-373-2 e-ISBN 978-1-60327-376-3 DOI 10.1007/978-1-60327-376-3 Library of Congress Control Number: 2009934120 © Humana Press, a part of Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Cover illustration: Printed on acid-free paper springer.com
To my daughters, Ophira and Feridey
Preface to 2nd Edition You are not obliged to complete the task, Nor are you free to stop trying. —Talmud, Avot Hepatocellular carcinoma (HCC) used to be regarded as a rare disease. The increasing numbers of chronic HCV carriers in the USA and subsequent increased incidence of HCC seen in most large medical centers mean that it is no longer an uncommon disease for gastroenterologists or oncologists to encounter, and its incidence and epidemiology are changing (new chapter). This has been enhanced by the appreciation that obesity (NASH or NAFL)-associated cirrhosis is also a cause of HCC, as are many metabolic syndromes (new chapter), in addition to carcinogens in the environment (new chapter), hepatitis B (new chapter), and hepatitis C (new chapter). Associated with this has been a clearer understanding of the many mechanisms involved in carcinogenesis of the liver (new chapter). During the period when liver resection and systemic chemotherapy were the only real therapeutic modalities available, the outcomes were generally dismal, especially since most patients presented with advanced-stage tumors. Several recent factors seem to
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