Liver cancer (HCC) is much less common in the Western world that subhariana Africa and Asia. In recent continents incidence is so high that, overall, worldwide, is one of the most common, with 1 million new cases each year.
In Europe more influence in Portugal, Greece and Spain than in other countries is observed.

– Epidemiology In Europe and the United States accounts for 0.75% of all tumors while in South Africa constitutes 20%. In areas where it is abundant, the age of onset is earlier while in the regions with low incidence is later, around the 6th decade of life.
It is 4-8 times more common in men than in women.

– CAUSES AND RISK FACTORS The CH has a great relationship with chronic liver problems. Alcoholic cirrhosis is closely related to the CH: about 4% of patients with cirrhosis develop CH and about 50% of patients with CH, they are cirrhotic. From this standpoint, the alcohol is a causal factor CH indirectly. The type B hepatitis has a great relationship with the CH, which would explain the greater abundance of this cancer in areas such as Africa and Asia Hepatitis C is more common. About 90% of patients are positive CH hepatitis B.

– PATHOLOGY 90% of CH are hepatocellular carcinomas (HCC). The remaining 10% are colangiosarcomas and colangiohepatomas.
The CH three forms of presentation:
a) A single mass. It is preferably located in the right lobe of the liver.
b) Variety nodular, multiple lesions in both lobes of the liver (75% of cases).
c), the most common, with multiple diffuse tumor masses or mass. It is frequently associated with cirrhosis.

– Clinical Features The CH usually a first silent phase, diagnosis difficult in the early stages.
With prior liver cirrhosis, the diagnosis is difficult, since the patient already has symptoms of liver disease.
Patients have fever, loss of appetite and weight loss. Sometimes (30% of patients) palpable mass in the abdomen. They can develop ascites (abdominal fluid).

– Diagnosis Patients with hepatitis B should be carefully monitored for the risk mentioned that this disease poses to the development of CH.
Suspecting CH practiced liver ultrasound with biopsy directed toward the suspected area. You can complete the imaging with CT or MRI.
50 to 70% of CH accompanied by the production of a marker alpha-fetoprotein. This substance is present in the fetus and newborn, but not in normal adult. Dr. Tartarinov discovered a protein (an alpha globulin) alpha-like protein, in the serum of patients with HC. Several studies have shown that alpha-fetoprotein is quite specific CH, so it is always determined to confirm or exclude the diagnosis of CH in patients who are positive. Note that also elevated in patients with hepatitis B.

– EXTENSION DIAGNOSIS proposed the following classification is followed by the AJCC
T, primary tumor
T1, one without invasion of tumor blood vessels.
T2, but with a single invasion of tumor blood vessels; or multiple
T3, or multiple tumors larger than 5 cm or tumor affecting a major branch of the portal or hepatic veins.
T4, a tumor or more with direct invasion of adjacent organs other than the gallbladder or with perforation of the visceral peritoneum bladder.
N, regional lymph
N0, no involvement.
N1, there is involvement of regional nodes.
M1, distant metastases
M0, no.
M1, no distant metastases.

– Treatment Treatment is based on the extent of the tumor (TNM), functional status of the liver and overall condition.
1. localized cases (T1-T3 and T4 some, DND). Only 5% of cirrhosis patients without tumor resection is possible. In these favorable cases have surgery without postoperative treatment.
In patients with liver cirrhosis can be practiced surgical removal or liver transplantation (but only 5% of patients can receive transplants CH). In these cases the prognosis is quite favorable, with 75% alive at 5 years after treatment patients.
2. unresectable localized cases (some T2, T3 and T4). It should try to complete removal followed by liver transplantation or local tumor ablation.
The local tumor ablation can be attempted by different means:
* Chemical embolization through the hepatic artery, in patients with good liver function and multiple tumors without invasion of vessels or tumor spread beyond the liver. Intra-arterial injection of adriamycin combined with cisplatin or mitomycin C is practiced
* Injection through the skin of alcohol (ethanol) in patients with up to 3 or 4 tumors, none exceeding 5 cm diameter
* Radiofrequency, when less than four tumors without any greater than 5 centimeters. Radiofrequency is a technique of tumor destruction by heat, which is sent to the tumor through probes inserted in the or the same. The probe is connected with a machine providing high frequency alternating current, which heats (“cooked”) tumors at temperatures of 90 to 100 degrees Celsius. The success of this technique is higher in smaller tumors and decreases in larger tumors. The probes can be applied through the skin but have less insertion failures in the tumor when applied by laparoscopy or open surgery.
If these options fail may include the patients in treatment support. Systemic chemotherapy by adriamycin or cisplatin does not improve survival.

– Patients with lymph AND / OR POSITIVE METASTASES a series of treatments, including chemotherapy, but was trying with little success. Supportive treatment is recommended.