Clin Liver Dis 9 (2005) xi xii

Preface

Hepatocellular Carcinoma

Morris Sherman, MS BCh, PhD, FRCP(C)

Guest Editor

In North America and Europe over the last 10 years or so, hepatocellular
carcinoma (HCC) has become a much more common disease than in the past and
is demanding more attention from clinicians. Along with this increase in in-
cidence has come the realization that very little was known about HCC. A decade
ago there were very few randomized controlled trials of therapy, the efficacy of
screening was unknown (though it was presumed to be present), and little was
known about the pathogenesis of this disease. Staging systems were rudimen-
tary and had been developed without the appropriate statistical tools. Since then,
the medical literature dealing with HCC has expanded considerably, and many
studies have been conducted with increasing rigor; consequently, there is now
some solid information in at least some aspects of this disease.
HCC has become very topical. The first international consensus conference on
HCC management was in 2001, sponsored by the European Association for the
Study of the Liver. A follow-up conference is due in 2005. In 2003 the American
Association for the Study of Liver Diseases hosted a single-topic research
symposium on HCC, and in 2004 the National Institutes of Health also held a
research symposium on HCC. This issue of the Clinics in Liver Disease thus
continues a trend of highlighting the importance of this disease for patients who
have underlying liver disease.
This issue attempts to present some of the new information about HCC that
has emerged over the last few years. Dr. Bosch and his colleagues describe the

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xii preface

epidemiology of this disease and highlight how the incidence is increasing in

parts of the world where it was previously considered to be a low-incidence
disease. Drs. Daniele and Perrone discuss the difference between staging and
scoring systems for HCC and describe current prognostic systems. Dr. Kim
presents alternative ways of looking at disease in the absence of solid evidence
by using modeling techniques. Screening for HCC remains controversial.
Dr. Marrero clarifies some of the issues around the use of screening tests, par-
ticularly serologic screening tests, and indicates where in the development pro-
cess these tests are. Imaging of HCC is crucial to both screening and to
management. Dr. Wilson and colleagues present a discussion of the radiological
features of HCC and present new information about the use of contrast-enhanced
ultrasonography, a tool surely destined to be very useful in the management of
this disease. The other diagnostic modality is of course biopsy, and Dr. Wanless
discusses the difficulties in differentiating malignant from nonmalignant tissue
in small lesions found on screening. There is a difference in interpretation
between Japanese pathologists and Western pathologists as to where the dividing
line between malignant and nonmalignant lies, and this is also discussed.
There are three articles devoted to therapy for HCC, including an assessment
of embolization and chemoembolization by Dr. Befeler, of local ablative thera-
pies by Dr. Lencioni and of transplantation for HCC beyond the usual criteria
by Drs. Roayaie and Llovet. Finally, Dr. Craxi and Camma discuss prevention
of HCC.
All the authors have been selected for their expertise in the areas described
in their respective articles. It is the hope of the editors that the information pre-
sented here will be helpful to readers in understanding important aspects of the
management of HCC. Just as important, we hope that this information highlights
what we do not know as much as what we do know, and that it points the way to
further studies.

Morris Sherman, MS BCh, PhD, FRCP(C)

Toronto General Hospital, 9N981
200 Elizabeth Street
Toronto, Ontario M5G 2C4, Canada
E-mail address: morris.sherman@uhn.on.ca