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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prefacexii

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, 9N–981

200 Elizabeth Street

Toronto, Ontario M5G 2C4, Canada

E-mail address: morris.sherman@uhn.on.ca