Hepatocellular Carcinoma Essay

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DISCUSSION
CLASSIFICATION OF HEPATOCELLULAR CARCINOMA
Hepatocellular carcinoma (HCC) is a primary malignancy of the liver. HCC is now the third foremost cause of cancer deaths. It is a destructive tumour that most commonly occurs in a background of chronic liver disease and cirrhosis. The occurrence of HCC is most frequent in Asia and Africa. This can be attributed to the high prevalence of hepatitis B and hepatitis C which strongly influences the development of chronic liver disease and the ensuing development of HCC. It is unfortunately identified very late in the disease progression, and thus has a median survival following diagnosis that ranges from 6 to 20 months1.
The presentation of HCC has changed significantly over recent years especially in developed countries. In the past, HCC generally presented at an advanced stage with right upper quadrant pain, weight loss, and signs of decompensated liver disease. It is currently more regularly identified at an earlier stage as a result of routine screening of patients with known cirrhosis. This screening usually comes in the form of imaging studies and serum alpha-fetoprotein measurements2.
In terms of management, certain patients may profit from liver resections. Numerous patients given the advanced stage of their cancer at diagnosis or their grade of liver disease could be cured by liver transplantation. Worldwide, only a minute percentage of all patients have access to transplantation. However, organ shortage is still the fundamental problem. In these patients, local ablative therapies, including radiofrequency ablation, chemoembolization, and potentially novel chemotherapeutic agents, may extend life and provide palliation.
Currently available therapeutic options for HCC are ...

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...method of management is correct and in keeping with suggested evidence based medicine. A potential future step in managing Mr. Burombo is to add doxorubicin. The benefit of this combination was studied in a phase II trial whereby all patients had received doxorubicin and they were randomly prescribed either sorafenib or a placebo. The combination therapy showed an improvement in median time to progression, overall survival, and progression-free survival when compared to monotherapy. However, important variables to consider is the fact that the population group of the study included patients who were diagnosed with advanced HCC and that had a Child Pugh stage A. Currently the combination of sorafenib and doxorubicin is not yet available for clinical use12. Further studies are also required to assess the efficacy of this combination against sorafinib alone.

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