الفهرس 
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Abstract
HCC is the commonest primary tumour of the liver.There is
increase in the rate of incidence of HCC in the world.HCC is
the 3rd common cancer in males.It is the 5th common cancer
in females. There is increase in the incidence of HCC in
Egypt.This may be due to increased exposure to risk factors
e.g HBV , HCV and liver cirrhosis.
* The risk factors to HCC are multiple and may
include:liver cirrhosis , chronic HBV infection , chronic HCV
infection , hereditary haemochromatosis , hereditary
tyrosinemia , autoimmune hepatitis , nonalcoholic
steatohepatitis and other risk factors.
*The common symptoms due to HCC may be
abdominal pain , malaise , anorexia , nausea , vomiting ,
variceal bleeding , loss of weight and jaundice. The common
signs due to HCC may be hepatomegaly , jaundice , hepatic
bruit , ascitis , splenomegaly .There may be spontaneous
bacterial peritonitis , metastasis , paraneoplastic syndrome e.g
diarrhea , erythrocytosis , hypoglycemia or carcinoid
syndrome.
* The screening to HCC could be done by s.AFP alone
or imaging methods alone e.g US , CT , MRI or a
combination of s. AFP and imaging methods.
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*The diagnosis of HCC should include the following:
1-serum HCC tumour markers:e.g s.AFP or s. DCP . s.
AFP > 400 ng/ml is diagnostic of HCC.
2-Imaging methods:e.g US , CT , MRI , scintigraphy or
angiographic imaging. US can be used in combination with
s. AFP to screen to HCC.These imaging methods can detect
vascular invasion of HCC.
3-PANB.
4-Assesment of the liver functions:It could be done by the
Child-Pugh scoring system or by the Model for End Stage
Liver Disease scoring system.
* There are diferrent staging systems to HCC e.g
BCLC , CLIP , Okuda or TNM staging systems.
There are different treatment options to HCC e.g tumour
resection , liver transplantation , PEI , RFA , TACE ,
antineoplastic drugs or symptomatic treatment.
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*Treatment :There are different treatment options to HCC
e.g
1-Tumour resection:It may be a curative treatment to
HCC. it is recommended to few number of patients with
HCC because most of patients with HCC have advanced
liver disease and/or decreased liver function. After HCC
resection , relapse may occur. relapse may be due to the
resected tumour was incompletely treated at the first time or
a second tumour not related to the first tumour occurred in
the liver.
2-Liver transplantation:May be considered in any patient
with liver cirrhosis and HCC single nodule < 5 cm or 3
nodules < 3 cm.
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*The success of liver transplantation has increased steadily
over the last two decades and several advances have been
made since the first human liver transplantation. This
procedure has become routine with an excellent outcome in
both quality and length of life.
*The result of liver transplantation has improved due to
advances in preoperative techniques, abetter understanding of
the cause and prognosis of several liver diseases and more
effective in post-operative care.
*Overall, liver transplant recipients enjoy a good quality of
life and often return to employment. Female recipients are
allowed pregnancy and the risk is generally small. This
evolution is mainly the result of standardization of the
technique and improved patient.
* Liver regeneration occurs rapidly after transplantation .A
study using serial MRI measurements showed that donor and
recipient mass increased by 144% and 99%, respectively, by 2
months. Regeneration appears to be greatest in the first week,
using CT scans to assess liver regeneration in recipients and
donors found an increase in donor and recipient liver size of
42% ± 26% vs. 86% ± 11%,67% ± 41% vs. 120% ± 27%, and
74% ± 46% vs. 75% ± 37% at 1,2, and 6 months, respectively.
The overall the rate of growth was greater of the recipient than
donor (Terrault NA .2002).