Jagannath S, Puri K, Kantsevoy S, Thuluvath P J
Department of Medicine, The Johns Hopkins Hospital, 1830 Monument Street, Baltimore, MD 21287, USA.
Minerva Gastroenterol Dietol. 2008 Jun;54(2):125-30.
Liver cancer is one of the most frequent solid cancers. The major risk factor associated with the development of hepatocellular carcinoma (HCC) is cirrhosis caused by hepatitis B, hepatitis C virus or chronic alcohol consumption. The overall prognosis of patients with HCC is very poor and this is mainly due to the advanced stages of cancer at presentation and also because of underlying cirrhosis. When HCC is diagnosed at early stages, prognosis is better with five-year disease free survival of around 50% with resection, or local ablative treatments such as radio-frequency ablation or percutaneous ethanol injection, and 70-80% with liver transplantation. Therefore, systematic screening of all the high-risk patients is the key to an early diagnosis of small HCC and the use of an appropriate treatment modality. The currently available tools for the screening, surveillance and diagnosis of HCC in the presence of cirrhosis remain sub-optimal. The advancements made in the past 10 years, however, have made HCC a potentially curable disease in a highly selected group of patients. This review will briefly discuss the current guidelines for surveillance and diagnosis of HCC in high-risk subjects and then review the potential role of endoscopic ultrasound and fine needle aspiration for the diagnosis of small HCC.
肝癌是最常见的实体癌之一。与肝细胞癌（HCC）发生相关的主要危险因素是由乙型肝炎、丙型肝炎病毒或长期饮酒引起的肝硬化。HCC患者的总体预后非常差，这主要是由于就诊时癌症已处于晚期，以及潜在的肝硬化。当HCC在早期被诊断时，预后较好，切除术后五年无病生存率约为50%，射频消融或经皮乙醇注射等局部消融治疗的五年无病生存率为50%左右，肝移植的五年无病生存率为70 - 80%。因此，对所有高危患者进行系统筛查是早期诊断小肝癌并采用适当治疗方式的关键。目前在肝硬化患者中用于HCC筛查、监测和诊断的现有工具仍不尽人意。然而，过去10年取得的进展已使HCC在高度选择的一组患者中成为一种潜在可治愈的疾病。本综述将简要讨论高危人群中HCC监测和诊断的当前指南，然后回顾内镜超声和细针穿刺抽吸在小肝癌诊断中的潜在作用。
