In the UK, biannual ultrasound is recommended, following European Association for the Study of the Liver guidelines (see Table 1 ). While recommendations regarding inclusion of AFP as part of HCC surveillance varies between guidelines, there is consensus among all professional bodies that ultrasound is required for HCC surveillance . Results from several studies have showed that HCC surveillance is cost-effective, although there is ongoing debate as to whether this is consistent across all aetiologies of CLD . Research involving cohort studies and mathematical modelling conclude that HCC surveillance results in earlier diagnosis, receipt of curative treatments and improved survival . In HCC, potential benefits of early detection are that curative therapies, such as resection or transplantation, could be offered sooner, resulting in improved survival rates .īiannual ultrasound and alpha-fetoprotein (AFP) measurement are the diagnostic tests used for surveillance they are widely available, affordable and have evidence supporting their utility. Around 90% of HCC cases have a background of cirrhosis or chronic liver disease, identifying individuals with these conditions as target ‘at risk’ populations for receipt of a surveillance test. Owing to poor prognosis and low surveillance uptake, HCC presents unique challenges to the NHS because half of UK cases are considered preventable . Other, rarer aetiologies include alpha 1 antitrypsin disorder, haemochromatosis and primary biliary cholangitis . Increasing age, male sex and smoking are also independent risk factors for HCC . The incidence of NASH is rising as metabolic syndrome becomes a common phenomenon and 20% of HCC cases have NASH as the attributable factor in the UK and United States . In the UK and United States, alcohol-related liver cirrhosis and non-alcoholic steatohepatitis (NASH) are significant causative factors for HCC. However, the attributable risk of HCV has decreased since the advent of antiviral medication, which results in sustained virological response (undetectable viral load six months after completion of treatment) . Hepatitis C virus (HCV) remains the most common aetiology of HCC in Western Europe, North America and Japan . HBV is the main causative factor of HCC in East Asia, which has the highest HCC incidence in the world. Hepatitis B virus (HBV) is directly oncogenic and is the most significant risk factor for developing HCC - it is responsible for 50% of HCC cases . Globally, viral hepatitis remains the most common cause of HCC . The epidemiology of HCC varies by region. This article will outline the importance of surveillance and how HCC is diagnosed, and will provide an overview of the current available treatment options, including the involvement of pharmacy teams where appropriate. Considering the rise in cases and the potential burden of the condition for patients, it is important that pharmacists are aware of the signs of HCC and know how to appropriately refer. Prognosis remains poor, with five-year survival rates less than 20% this is unchanged in the past decade despite advances in therapeutics . The average age at diagnosis is 69 years and the majority of cases occur in men . The incidence of HCC is rising: new cases have increased by 160% over the past three decades in the UK alone, with around 17 new cases diagnosed per day . It is the sixth most common cancer worldwide, with 905,700 new cases in 2020, and is the fourth most common cause of cancer-related death, responsible for 830,200 deaths each year . Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is a growing global health concern. Understand the main treatment options for HCC and which patients are eligible for curative treatment.Identify the risk factors for developing hepatocellular cancer (HCC) and understand which patients require surveillance.Journal of Pharmaceutical Health Services ResearchĪfter reading this article, you should be able to:.International Journal of Pharmacy Practice.Antimicrobial resistance and stewardship.
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