Hepatocellular carcinoma in cirrhotic liver

Hepatocellular carcinoma (HCC) is a primary malignant tumour (cancer) of the liver. Most HCCs occur in livers that have been damaged by chronic disease processes like cirrhosis. Thus HCC is a 'tumour in a tumour generating environment'.Certain patients with liver disease eg those with tyrosinaemia, haemochromatosis or hepatitis B are at much higher risk of developing cancers than others. Once HCC develops, the chances of survival decline rapidly unless detected and managed early. Hence all cirrhotics should be under surveillance for HCC with ultrasound and alpha-fetoprotein (AFP) levels at least every 6 months. When HCC is suspected this should be supplemented by contrast axial imaging (CT/MRI) and/or biopsy. Biopsy can be hazardous in patients with advanced disease due to ascites, coagulopathy and risk of tumour spread. Without a biopsy it may be difficult to conclusively prove or disprove presence of HCC since no imaging or tumour marker is 100% accurate. If the suspicion is strong and biopsy is considered very risky, the patient should be assumed to be having HCC and treated as such.

Cirrhosis in alcohol abusers

One of the major causes of Liver Cirrhosis is alcohol. Alcohol causes liver damage through various mechanisms not necessarily in direct proportion to the amount of alcohol consumed. Moreover concurrent alcohol abuse augments the liver damage due to a host of other problems notably Hepatitis C. Many people who have alcoholic liver disease demonstrate no features of physical dependence; yet they find it difficult to stop. The first step is recognising the problem through help of medical professionals, family support and counselling. When alcoholic patients with cirrhosis stop consumption there can sometimes be a dramatic change in their condition that may help postpone the need for transplant if not totally eliminate it. To be considered for a transplant, patients who have alcoholic cirrhosis must have been abstinent for at least 6 months (under supervision) and must have demonstrated the will to be compliant and have a good family and social support. Young patients who have been abstinent for shorter periods but are seriously ill and otherwise suitable to merit a transplant can pose an ethical dilemma in the transplantation. community.