world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
USA and the percentage is much lower in<br />
developing countries (Fig. 5.44).<br />
In the absence of extrahepatic disease,<br />
resection with negative pathologic margins<br />
is the mainstay of treatment for<br />
malignant liver neoplasms. In patients in<br />
whom a small liver remnant is anticipated,<br />
portal vein embolization is used to<br />
increase the size of the future liver remnant<br />
[11]. The fact that most hepatocellular<br />
carcinomas occur in a cirrhotic liver<br />
excludes many patients from consideration<br />
for surgical resection, due to the risk<br />
of liver failure. Other techniques used<br />
alone or as an adjuvant to resection<br />
include radiofrequency ablation and<br />
cryoablation. Liver transplantation has<br />
been performed in non-resectable<br />
patients, although use of this procedure<br />
has declined due to a number of factors,<br />
including the frequency of death from<br />
tumour recurrence, especially in the<br />
transplanted liver, and organ shortages.<br />
Hepatocellular carcinoma is largely radiotherapy<br />
resistant [10]. Nonsurgical treatments<br />
include hepatic artery infusion of<br />
drugs or thrombotic agents (port or<br />
pump), chemoembolization and percutaneous<br />
alcohol or acetic acid injection,<br />
although side-effects are many and benefit<br />
to the unresectable patient is doubtful<br />
[4,11]. Hepatic intra-arterial iodine 131labelled<br />
lipiodol (iodized poppy seed oil)<br />
shows promise for the future [4,12].<br />
Recent results suggest that a chemother-<br />
206 Human <strong>cancer</strong>s by organ site<br />
Fig. 5.44 Five-year relative survival after diagnosis<br />
of liver <strong>cancer</strong>.<br />
apy regimen combining cisplatin, doxorubicin,<br />
interferon and 5-fluorouracil may<br />
elicit a response, although previously no<br />
agent, either singly or in combination, has<br />
been found to improve survival. Hormone<br />
therapy is also disappointing, although<br />
results with octreotide are more hopeful<br />
than with tamoxifen. Metastatic hepatocellular<br />
<strong>cancer</strong> commonly spreads to the<br />
lungs and bones. Response to chemother-<br />
Hepatocellular carcinoma<br />
Familial<br />
CDKN 2A, APC and BRCA2<br />
Sporadic<br />
HBV genome integration<br />
p53<br />
CDKN2A<br />
M6P/IGF2R<br />
SMAD gene family members<br />
Cyclin D and Cyclin A<br />
Altered MET function?<br />
Intrahepatic cholangiocarcinoma<br />
KRAS<br />
p53<br />
c-erbB2<br />
MET oncogene<br />
E-cadherin, α-cadherin, β-cadherin<br />
BCL2<br />
Telomerase<br />
Table 5.7 Genes involved in the development of<br />
liver <strong>cancer</strong>.<br />
apy and local regional therapy is poor [12].<br />
The liver is also a frequent site of metastases<br />
from <strong>cancer</strong>s at other sites, of which<br />
the most common is colorectal <strong>cancer</strong>.<br />
The poor prognosis and lack of effective<br />
therapies for hepatocellular <strong>cancer</strong> suggest<br />
that the development of prevention<br />
programmes is of critical importance<br />
(Hepatitis B vaccination, p144).