Hepatocellular Carcinoma

This essential book is a compendium of papers written by an international team of world-renowned experts, who cover topics in their respective areas of expertise. Presenting the most up-to-date knowledge of hepatocellular carcinoma, it covers all topics -- including those more controversial ones -- in this rapidly advancing field, from epidemiology to prevention, from molecular biology to gross pathology, from screening to atypical presentation, from diagnosis to treatment, and from assessment to choice of appropriate treatment. This volume is therefore an important contribution to the field of hepatocellular carcinoma. Contents: Epidemiology (T Y-M Leong & A S-Y Leong); Assessment of Liver Function (D V Mann); Prevention (M C Kew); Screening (M Sherman); Tumor Markers (J Y H Chan & Z Wang); Imaging (S S M Ho & S C H Yu); Pathology (A S-Y Leong et al.); Molecular Aspects (J Y H Chan et al.); Staging (J M Burns & F L Greene); Selection of Patients for Liver Resection (E C H Lai et al.); Intraoperative Ultrasound (G Torzilli & H Bismuth); Intrahepatic Glissonian Approach (B Launois & K H Tay); Laparoscopic Liver Resection (R Liu); Techniques of Liver Transection (E T Castaldo & C W Pinson); Cryosurgery (G Petrou & D L Morris); Local Ablative Therapy (T Livraghi); Systemic Chemotherapy (T W T Leung); Palliative Care (W Yeo & A T C Chan); and other papers. Contents......Page 12 Preface......Page 8 Acknowledgments......Page 10 List of Contributors......Page 16 Introduction......Page 24 Geographic Distribution......Page 25 Risk Factors......Page 26 Age and gender......Page 27 Genetic and congenital abnormalities......Page 29 Hepatitis B virus (HBV)......Page 31 Hepatitis C virus (HCV)......Page 32 Other hepatitis viruses......Page 33 Chemical carcinogens......Page 34 Miscellaneous factors......Page 35 Precancerous Changes and Hepatocarcinogenesis......Page 37 Relationship of Etiological Agents and Molecular Events......Page 38 References......Page 41 The importance of hepatic terminology......Page 48 First-order division......Page 49 Second-order division......Page 50 Third-order division......Page 53 Hepatic arteries and liver resections......Page 55 Prevailing pattern and anomalies of bile ducts draining the right hemiliver......Page 58 Prevailing pattern and important variations of bile ducts draining the left hemiliver......Page 60 Portal vein and liver resections......Page 62 Hepatic veins and liver resections......Page 65 Portal sheaths and liver plates......Page 69 Effect of pathological conditions on anatomical structures......Page 70 Addendum Regarding Liver Anatomy and Terminology......Page 71 References......Page 72 Introduction......Page 74 Bilirubin......Page 77 Albumin......Page 78 Prognostic clinicolaboratory scoring......Page 79 Model for End-stage Liver Disease (MELD)......Page 80 Bioenergetic Tests......Page 81 Peripheral blood redox state......Page 83 Tissue adenine nucleotide and mitochondrial analysis......Page 84 Magnetic resonance spectroscopy......Page 85 Radiological Imaging and Qualitative Assessments......Page 88 Clearance tests......Page 89 Indocyanine green (ICG) test......Page 90 Microsomal capacity tests......Page 92 Lidocaine and MEGX......Page 93 Glucose load: redox tolerance test......Page 94 Asialoglycoprotein receptor scintigraphy......Page 95 Regenerative capacity: portal vein embolization......Page 96 Longitudinal Evaluation After Hepatectomy......Page 97 References......Page 102 Is There a Need to Prevent Hepatocellular Carcinoma?......Page 108 Definition of Cancer Prevention......Page 109 Etiology of Hepatocellular Carcinoma......Page 110 Chronic hepatitis B virus infection......Page 111 Chronic hepatitis C virus infection......Page 113 Cirrhosis......Page 114 Aflatoxins......Page 115 Iron storage diseases......Page 116 Microcystins......Page 118 Alpha-1 antitrypsin deficiency......Page 119 Glycogen storage diseases......Page 120 Wilson’s disease......Page 121 Immunization against hepatitis B virus infection......Page 122 Other forms of primary prevention against hepatitis B and C virus infections......Page 125 Prevention of exposure to aflatoxin B1 (AFB1)......Page 127 Membranous obstruction of the inferior vena cava......Page 129 Chemoprevention of aflatoxin B1-induced hepatocellular carcinoma......Page 130 Polyprenoic acid......Page 133 Iron storage diseases......Page 134 Type II hypercitrullinemia......Page 135 Use of interferon-α in preventing hepatitis C virus–induced hepatocellular carcinoma......Page 136 Use of interferon-α in preventing chronic hepatitis B virus–induced hepatocellular carcinoma......Page 138 Glycyrrhizin......Page 139 Prevention of Recurrence of Hepatocellular Carcinoma......Page 140 References......Page 141 Introduction......Page 152 Screening Tests......Page 153 Surveillance Interval......Page 154 Target Populations......Page 155 Does Screening Reduce HCC-related Mortality?......Page 156 Dealing with Abnormal Screening Test Results......Page 157 A Screening Program......Page 159 Summary......Page 160 References......Page 161 Clinical Presentation: Epidemiologic Differences......Page 166 References......Page 177 Introduction......Page 182 Oncofetal Antigens and Glycoprotein Antigens......Page 184 Gamma-glutamyl transferase......Page 188 Alpha-L-fucosidase......Page 189 Des-gamma-carboxy prothrombin......Page 190 Golgi protein 73 (GP73)......Page 192 Interleukin-8......Page 193 Tumor-specific growth factor......Page 194 Alpha-fetoprotein (AFP) mRNA......Page 195 Gamma-glutamyl transferase (GGT) mRNA......Page 196 Oncogenes, tumor suppressors, and telomerase reverse transcriptase......Page 197 Conclusions......Page 198 References......Page 200 Incidence and Etiology......Page 206 Pathology and Imaging Features of HCC......Page 207 Ultrasonography......Page 216 Computed tomography (CT)......Page 219 Magnetic resonance imaging (MRI)......Page 223 Angiography......Page 229 Positron emission tomography (PET)......Page 230 References......Page 233 Gross Appearance......Page 238 Architectural variants......Page 241 Cytological variants......Page 244 Cytoplasmic inclusions......Page 246 Grading......Page 247 Natural History and Spread......Page 248 Small HCC......Page 250 Dysplasia......Page 251 Dysplastic nodules......Page 253 Hepatocellular adenoma......Page 254 Focal nodular hyperplasia (FNH)......Page 255 Nodular regenerative hyperplasia......Page 256 Combined HCC and Cholangiocarcinoma......Page 257 Hepatoblastoma......Page 258 Immunohistology......Page 259 Conclusions......Page 261 References......Page 262 Introduction......Page 266 The life cycle of HBV and the genomes of HBV and HCV......Page 268 Insertional mutagenesis and cis-activation of cellular genes by HBV DNA......Page 271 Trans-activation of cellular genes by HBV DNA......Page 272 Interactions Between Chemical Carcinogens, HBV, and Cellular Genes......Page 274 “Yin–Yang” (Negative and Positive) Regulation of Hepatocarcinogenesis: Alterations of Proto-oncogenes, Tumor Suppressors, and Other Critical Genes in HCC......Page 276 Genomic Instability and Chromosomal Alterations in HCC......Page 279 Comparative genomic hybridization analysis......Page 280 Chromosome 16q and E-cadherin......Page 281 Chromosome 13q and Rb and BRCA2......Page 282 Chromosome 9p and p16......Page 283 Reactivation of telomerase activity in HCC......Page 284 Reactive Oxygen Species and HCC......Page 285 Carcinogens and ROSs......Page 286 Growth factors, oncogenes, and ROSs......Page 287 Human HCC and ROSs......Page 288 Gene Profiling, Microarray, and Proteomics in HCC......Page 289 Gene Transfer and Immunotherapy in HCC......Page 294 References......Page 295 Introduction......Page 302 TNM......Page 304 Okuda......Page 307 Cancer of the Liver Italian Program (CLIP)......Page 308 Barcelona Clinic Liver Cancer (BCLC)......Page 310 Chinese University Prognostic Index (CUPI)......Page 314 Japanese Integrated Staging (JIS)......Page 315 Modified CLIP and JIS Staging Systems......Page 318 Discussion......Page 320 References......Page 321 Introduction......Page 326 Assessment of Tumor Extent......Page 327 HCC with adjacent organ involvement......Page 329 HCC with vascular invasion......Page 330 Assessment of Liver Functional Reserve......Page 331 References......Page 335 Introduction......Page 340 Problems Associated with Cirrhotic Liver Resection for HCC......Page 341 Patient selection criteria......Page 343 Determination of extent of liver resection......Page 344 Controlling bleeding and limiting blood transfusion in cirrhotic patients......Page 348 Patient management......Page 352 Policy of intra-abdominal drain......Page 353 References......Page 354 Introduction......Page 360 Technique of PVE......Page 362 Transileocolic venous approach......Page 363 Transhepatic approach......Page 364 Embolization materials......Page 365 Portal pressure after PVE......Page 367 Volumetric changes after PVE......Page 368 Functional changes after PVE......Page 370 Indication of PVE for HCC patients......Page 371 Role of transcatheter arterial chemoembolization (TACE)......Page 372 Effect of PVE on diseased liver......Page 373 Results of hepatic resection after PVE......Page 375 References......Page 377 Introduction......Page 382 Technical Aspects......Page 383 Ultrasound liver anatomy......Page 384 Detection and differentiation of liver nodules......Page 387 Tumor location......Page 391 Types of surgical approaches......Page 392 Liver parenchymal dissection......Page 399 Postresectional control......Page 405 References......Page 406 16. Surgical Treatment Jacques Belghiti......Page 410 Radiological Imaging......Page 411 Patient Selection......Page 413 Preoperative Evaluation of Liver Functional Reserve......Page 415 HCC with Chronic Liver Disease......Page 417 Improvement of surgical resection......Page 418 Anterior approach......Page 419 Results of Liver Resection......Page 420 Liver Resection and Liver Transplantation (LT)......Page 421 References......Page 423 Introduction......Page 432 Theoretical Advantages of the Anterior Approach......Page 433 The Hanging Maneuver: Principles and Technical Procedure......Page 435 Results of the Anterior Approach and of the Liver Hanging Maneuver......Page 438 References......Page 440 Introduction......Page 442 Rationale for Segment-based Liver Resection......Page 443 Technique of Segment-based Liver Resection......Page 445 Surface anatomy + IOUS......Page 446 Preliminary control of the vascular pedicles of the segment to be removed......Page 447 Selective portal venous occlusion using a balloon catheter through a branch of the superior mesenteric vein......Page 448 References......Page 449 Introduction......Page 452 Intrafascial or hilar (extrahepatic) approach......Page 453 Extrafascial approach1,4–10......Page 454 Principles of the anterior intrahepatic approach......Page 456 Approach to the confluence, the right main pedicle, and the right medial pedicle......Page 458 Hepatectomies......Page 462 Sectorectomies and Segmentectomies......Page 465 Indications and Discussion......Page 466 References......Page 468 Introduction......Page 470 Indications......Page 471 Operative Procedure......Page 473 Identification of tumor-bearing segment/subsegment......Page 474 Recognition of the correct ligation point on the portal branch......Page 476 Resection of the liver parenchyma under intermittent blood inflow occlusion......Page 477 Anatomic resection of segment 8......Page 479 Other types of segmentectomies......Page 481 Prognostic Impact of Segmentectomy/Subsegmentectomy......Page 482 References......Page 484 Introduction......Page 488 Anatomy......Page 489 Surgical Approaches to Caudate Lobectomy......Page 492 Indications......Page 493 Taping the IVC......Page 494 Detachment from the IVC and the third porta hepatis......Page 495 Detachment from the hilum and the first porta hepatis......Page 496 Detachment from the neighboring liver, hepatic veins, and second porta hepatis......Page 497 Indications......Page 500 Surgical procedure......Page 501 Retrograde caudate lobectomy......Page 506 Dissection of the SHVs through a thickened caudate margin......Page 508 Application of the liver hanging maneuver......Page 510 References......Page 511 Introduction......Page 514 Indications (See Table 1)......Page 515 Instrumentation......Page 517 Limited resection......Page 519 Laparoscopic left lateral sectionectomy......Page 520 Right hepatectomy......Page 521 Results......Page 522 Complications......Page 523 The Role of Laparoscopic Liver Resection......Page 524 Conclusions......Page 525 References......Page 526 Introduction......Page 530 Technique......Page 531 Indications......Page 534 Technique......Page 535 Total Vascular Exclusion......Page 536 Technique......Page 537 Complications of Vascular Clamping......Page 539 Protective Strategies Against Prolonged Ischemia During Vascular Clamping......Page 540 Intermittent portal triad clamping......Page 541 Ischemic preconditioning with continuous inflow occlusion......Page 542 Intermittent portal triad clamping versus ischemic preconditioning......Page 543 Continuous inflow occlusion under in situ hypothermia......Page 544 Acknowledgment......Page 545 References......Page 546 Introduction......Page 552 Kelly Clamp Technique......Page 553 Ultrasonic Dissection......Page 554 Staplers......Page 555 Hydrojet......Page 557 Radiofrequency Energy......Page 559 LigaSure......Page 561 Harmonic Scalpel......Page 563 Wedge resection with parenchymal compression......Page 564 Vascular isolation......Page 565 Total vascular isolation......Page 566 Low central venous pressure......Page 567 Comparisons of Liver Transection Techniques......Page 568 References......Page 570 Introduction......Page 574 Principles......Page 575 Design of the Habib 4X......Page 576 Position of patient......Page 579 Dissection......Page 580 Transection of liver parenchyma......Page 582 Tumorectomy or segmentectomy......Page 586 Complications......Page 587 References......Page 589 Introduction......Page 592 Rationale for Cytoreduction......Page 593 Outcome of Cytoreductive Surgery for HCC......Page 595 Cytoreduction by Radiofrequency Ablation (RFA)......Page 597 Challenges of Cytoreductive Surgery for HCC......Page 599 References......Page 600 Introduction......Page 606 The History of Cryosurgery......Page 608 In vitro freezing of tissue......Page 609 Animal models......Page 610 Single Versus Double Freeze–Thaw Cycles......Page 611 Patient Selection: Indications for Hepatic Cryotherapy in HCC......Page 612 Preoperative investigation and preparation......Page 614 Equipment and personnel......Page 615 Operative approach......Page 618 Intraoperative ultrasound (IOUS) (Fig. 5)......Page 619 Cryoprobe placement and freezing process......Page 620 Laparoscopic cryosurgery......Page 622 Cracking of the treated lesion......Page 623 Biloma or bile fistula......Page 625 Cryoshock......Page 626 Efficacy of the Treatment of HCC with Cryosurgery (Table 2)......Page 627 Conclusions......Page 628 References......Page 629 Historical Overview and Introduction......Page 636 Epidemiology......Page 637 Clinical Presentation and Diagnosis......Page 639 Diagnostic Imaging Evaluation......Page 640 Staging (TNM, Okuda, CLIP, BCLC)......Page 645 Prognostic Factors and Selection Criteria......Page 649 Organ Allocation (MELD, UNOS)......Page 652 Orthotopic Liver Transplantation......Page 653 Living Donor Liver Transplantation (LDLT)......Page 654 Other Issues......Page 657 References......Page 658 Introduction......Page 668 Percutaneous ethanol injection (PEI)......Page 669 Radiofrequency ablation (RFA)......Page 670 Evaluation of Therapeutic Efficacy......Page 671 Percutaneous ethanol injection......Page 672 Radiofrequency ablation......Page 673 Conclusions......Page 674 References......Page 679 Introduction......Page 684 Transarterial Embolization (TAE)......Page 685 Transarterial Chemoembolization (TACE)......Page 686 Patient selection for TACE......Page 689 Complications of TACE......Page 690 TACE in unresectable HCC......Page 691 Downstaging of unresectable HCC by TACE to become resectable......Page 693 Adjuvant TACE after curative liver resection......Page 694 Neoadjuvant/Adjuvant TACE for liver transplantation......Page 695 TACE combined with other treatments......Page 696 Transarterial Radioembolization (TARE)......Page 697 Iodine-131(131I)–Lipiodol......Page 698 Neoadjuvant/Adjuvant transarterial 131I-lipiodol......Page 700 Yttrium-90 ( 90Y) microspheres......Page 701 Glass-based 90Y microspheres......Page 703 References......Page 705 31. Systemic Chemotherapy ThomasW. T. Leung......Page 718 Introduction......Page 719 Efficacy of Systemic Chemotherapy......Page 720 New Approaches in Systemic Chemotherapy......Page 726 Conclusions......Page 727 References......Page 728 Introduction......Page 732 Neoadjuvant transarterial chemoembolization (TACE)......Page 734 Adjuvant regional therapy......Page 736 Adjuvant regional and systemic therapy......Page 738 Adjuvant transarterial radioembolization (TARE)......Page 739 Adjuvant immunotherapy......Page 741 Chemoprevention with vitamin analog therapy after curative liver resection......Page 742 Neoadjuvant/Adjuvant Therapy in Liver Transplantation for HCC......Page 743 Neoadjuvant TACE......Page 744 Neoadjuvant local ablative therapy......Page 745 Salvage Surgery After Tumor Downstaging of Advanced HCC......Page 746 Indication and prerequisites for salvage surgery and tumor downstaging......Page 747 Results of salvage surgery after tumor downstaging Tumor downstaging with TACE......Page 748 Tumor downstaging with TAC......Page 749 Tumor downstaging with multimodality therapy......Page 750 Prognosis and survival......Page 751 References......Page 753 Introduction......Page 762 Liver resection......Page 763 TAC/TACE......Page 770 TARE/External radiotherapy......Page 772 Combination therapy......Page 775 References......Page 778 34. Palliative Care Winnie Yeo and Anthony T. C. Chan......Page 784 Quality-of-life assessment......Page 787 Cost of palliative care......Page 789 References......Page 791 Introduction......Page 796 Spontaneous Rupture......Page 797 Jaundice......Page 803 Esophageal Variceal Hemorrhage......Page 809 Hypoglycemia......Page 810 Erythrocytosis......Page 811 References......Page 812 Introduction......Page 816 Etiology......Page 817 Management......Page 819 Hepatocyte Transplantation......Page 821 Liver Dialysis (Liver Support)......Page 822 Artificial Liver Support......Page 824 Bioartificial Liver (BAL) Support......Page 825 Liver Transplantation......Page 827 Conclusions......Page 829 References......Page 830 Introduction......Page 836 High-Intensity Focused Ultrasound (HIFU)......Page 837 Conformal Radiotherapy......Page 840 Stereotactic Radiotherapy......Page 842 Proton Beam Therapy......Page 843 References......Page 844 Author Index......Page 850 Index......Page 852

This essential book is a compendium of papers written by an international team of world-renowned experts, who cover topics in their respective areas of expertise. Presenting the most up-to-date knowledge of hepatocellular carcinoma, it covers all topics - including those more controversial ones - in this rapidly advancing field, from epidemiology to prevention, from molecular biology to gross pathology, from screening to atypical presentation, from diagnosis to treatment, and from assessment to choice of appropriate treatment. This volume is therefore an important contribution to the field of hepatocellular carcinoma.

Doody Review Services

Reviewer:Thomas Collins, MD(University of Iowa Hospitals and Clinics)
Description:This authoritative and comprehensive book on hepatocellular carcinoma (HCC) adequately covers epidemiology, liver anatomy, biology of the disease, screening and diagnostic modalities, then extensively covers treatment options, complications, and outcomes.
Purpose:The editor aims to outline current aspects of the changing paradigm in the approach to patients with hepatocellular carcinoma. Over the past decade, the approach has become multidisciplinary for a multitude of reasons and thus requires a broader understanding in many fields of medicine. As HCC is one of the most common causes of malignant morbidity and mortality worldwide, a comprehensive book is certainly justified and this lengthy book very thoroughly covers the topic.
Audience:Unlike the typical book organized by body system or medical area of interest, this one covers one disease. I agree with the editor that the target audience is composed of two groups: practitioners treating patients and scientists with a research interest. However, I also feel that a comprehensive and up-to-date book on HCC will serve as an outstanding reference for medical students, residents, and practitioners in all fields and scientists researching related fields. Readers should understand, however, that HCC is far more prevalent in Asia and Africa than it is in Western developed countries and, as such, much of the data comes from patient populations that may not be congruent with patient populations in developed countries. Well known authorities write many chapters.
Features:Approximately half of the 37 chapters are dedicated to different aspects of treatment of HCC. The current approach to treating this disease is multimodal and multidisciplinary and this necessitates a thorough discussion of the many different treatment options. This is the strength of the book. It describes in a succinct manner not only the surgical approaches, but also the ablative therapies, chemotherapies, and transplantation. On a minor note, the chapter on ablation failed to mention microwave technology; although this is not a widely accepted modality, for the sake of completeness and because of its potentially easier application than RFA, it should be mentioned. Another very good aspect of the book is the generous use of color photographs. Color intraoperative photographs greatly enhance the understanding of the surgical anatomy and anatomic relationships. All of the illustrations and radiographs are black and white, but they are clear and appropriately used. One particularly difficult task in the field of liver surgery has been acceptance of a standard nomenclature. The use and excellent description of the Brisbane 2000 terminology is appropriate and hopefully a step towards standardization. The description of common anatomic anomalies in the liver is accurate and thorough. In addition to aspects of treatment, the book sufficiently covers the many other areas of hepatocellular carcinoma, including epidemiology, basic tumor biology, preoperative assessment and imaging, palliative care, and pathology.
Assessment:This book covers many aspects of a complex disease in a manner that allows a practitioner working within a multidisciplinary team to adequately understand the workup and treatment options. This disease is usually covered within the confines of a hepatology or even more generalized medical text. The premise of this book is unique: addressing only hepatocellular carcinoma and covering the broad range of disciplines that care of patients with this disease requires. It is because of this multidisciplinary approach that this book is quite useful for practitioners taking care of patients with this disease.

1. Epidemiology / Trishe Y.-M. Leong and Anthony S.-Y. Leong -- 2. Liver terminology and anatomy / Steven M. Strasberg -- 3. Assessment of liver function / Darren V. Mann -- 4. Prevention / Michael C. Kew -- 5. Screening / Morris Sherman -- 6. Presentation and diagnosis / Dario Ribero, Gareth Morris-Stiff and Jean-Nicolas Vauthey -- 7. Tumor markers / John Y.H. Chan and Zhi Wang -- 8. Imaging / Simon S.M. Ho and Simon C.H. Yu -- 9. Pathology / Anthony S.-Y. Leong, Trishe Y.-M. Leong and Pongsak Wannakrairot -- 10. Molecular aspects / John Y.H. Chan, Kenneth K.H. Lee, Yiu-Loon Chui and Macus T. Kuo -- 11. Staging / Justin M. Burns and Frederick L. Greene -- 12. Selection of patients for liver resection / Eric C.H. Lai, W.Y. Lau and Darren V. Mann -- 13. Problems associated with liver resection in cirrhotic patients / Cheng-Chung Wu -- 14. Preoperative portal vein embolization / Takuya Hashimoto and Masatoshi Makuuchi -- 15. Intraoperative ultrasound / Guido Torzilli and Henri Bismuth -- 16. Surgical treatment / Jacques Belghiti -- 17. Anterior approach using the hanging technique / Jacques Belghiti and Barbara Alkofer -- 18. Segment-based liver resection / W.Y. Lau and Eric C.H. Lai -- 19. Intrahepatic glissonian approach / Bernard Launois and Khoon Hean Tay -- 20. Ultrasonically guided segmentectomy and subsegmentectomy / Taku Aoki, Norihiro Kokudo and Masatoshi Makuuchi -- 21. Isolated caudate lobe resection (resection of couinaud segment 1) / Shu-You Peng -- 22. Laparoscopic Liver Resection / Rong Liu -- 23. Techniques of vascular control and protective strategies for parenchymal transection / Markus K. Müller, Henrik Petrowsky and Pierre-Alain Clavien -- 24. Techniques of liver transection / Eric T. Castaldo and C. Wright Pinson -- 25. Radiofrequency-assisted liver resection / Long R. Jiao and Nagy A. Habib -- 26. Cytoreductive (tumor-debulking) surgery / Eric C.H. Lai and W.Y. Lau -- 27. Cryosurgery / George Petrou and David L. Morris -- 28. Liver transplantation / Chao-Long Chen and Allan M. Concejero / 29. Local ablative therapy / Tito Livraghi -- 30. Regional therapy / W.Y. Lau and Eric C.H. Lai -- 31. Systemic chemotherapy / Thomas W.T. Leung -- 32. Neoadjuvant/adjuvant/chemoprevention therapy and tumor downstaging / W.Y. Lau and Eric C.H. Lai -- 33. Management of portal vein tumor thrombus / W.Y. Lau, Eric C.H. Lai and Simon C.H. Yu -- 34. Palliative care / Winnie Yeo and Anthony T.C. Chan -- 35. Management of specific complications / Eric C.H. Lai and W.Y. Lau -- 36. Management of acute liver failure / A.R. Nitin Rao -- 37. Extracorporeal energy therapy / Eric C.H. Lai and W.Y. Lau Hepatocellular Carcinoma represents a leading cause of cancer death and a major health problem in developing countries where hepatitis B infection is prevalent. It has also become increasingly important with the increase in hepatitis C infection in developed countries. Knowledge of hepatocellular carcinoma has progressed rapidly. This book is a compendium of papers written by experts to present the most up-to-date knowledge on hepatocellular carcinoma. This book deals mainly with the basic research aspect of hepatocellular carcinoma. The book is divided into three (I) Biomarkers / Therapeutic Target; (II) Carcinogenesis / Invasion / Metastasis; and (III) Detection / Prevention / Prevalence. There are 18 chapters in this book. This book is an important contribution to the basic research of hepatocellular carcinoma. The intended readers of this book are scientists and clinicians who are interested in research on hepatocellular carcinoma. Epidemiologists, pathologists, hospital administrators and drug manufacturers will also find this book useful. Lau (The Chinese University of Hong Kong) collects work by experts from 15 countries to present the latest understanding of hepatocellular carcinoma. Coverage encompasses all topics in the field, from epidemiology and prevention through molecular biology, gross pathology, screening and atypical presentations, diagnosis, treatment and management, surgery, and palliative care. There is also a chapter on treatment with extracorporeal energy therapy, covering high-intensity focused ultrasound, conformal radiotherapy, stereotactic radiotherapy, and proton beam therapy. Controversial areas are discussed from different perspectives. The readership for the book includes liver surgeons, hepatologists, interventional and diagnostic radiologists, and basic researchers. General physicians and surgeons, pathologists, and instrument manufacturers will also find the book useful. Annotation ©2008 Book News, Inc., Portland, OR (booknews.com)