Preamble: The recommendations provided in this document provide a data-supported approach to the diagnosis, staging and treatment of patients diagnosed with hepatocellular carcinoma (HCC). They are based on the following: (a) formal review and analysis of the recently-published world literature on the topic (Medline search through early 2010); (b) American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines1; (c) guideline policies, including the AASLD Policy on the Development and Use of Practice Guidelines and the American Gastroenterology Association Policy Statement on Guidelines2; (d) the experience of the authors. These recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. In an attempt to characterize the quality of evidence supporting recommendations, the Practice Guidelines Committee of the American Association for Study of Liver Disease (AASLD) requires a category to be assigned and reported with each recommendation (Table 1). These recommendations are fully endorsed by the American Association for the Study of Liver Diseases.
Introduction: The incidence of hepatocellular carcinoma is rising in many countries,3-8, but in a few areas such as Japan and Singapore, the incidence of HCC seems to have stabilized or even fallen slightly.9,10 Care of the patient with HCC involves physicians from different disciplines, including hepatologists, surgeons, liver transplant teams, oncologists, interventional radiologists, and to some extent radiation oncologists. In most settings, the role of the hepatologist or gastroenterologist in these multi-specialty groups (usually organized as Tumor Boards) is not based on specific expertise in the application of a given intervention, but rather in assessing the degree of liver function impairment prior to, during and after therapy. This specific expertise is important since HCC usually appears in the setting of underlying liver disease. This results in a degree of complexity that is not present in other cancer types that seldom compromise vital organ function. All this suggests that patients with HCC should be managed in multidisciplinary settings, with all legitimate treatment options available. Under these circumstances, the hepatologist is to be a focal point around whom the process revolves. At all times, the hepatologist should assess liver function and suitability of various therapies. The hepatologist should also be responsible for management of the liver disease before, during, and after cancer therapy. He/she must ensure that only treatments of proven value are administered, rather than treatments that are technically feasible but which have not been shown to enhance survival.