الفهرس 
ANATOMY OF THE LIVEROnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma(HCC) is the sixth most common cancer in the world (626,000 diagnoses per year) and is the third most common cause of cancer- related deaths (598,000 deaths per year) (Parkin et al., 2005).
The incidence ranges from <10 cases per 100 000 persons in North America and Western Europe to 50-150 cases per 100 000 persons in parts of Africa and Asia, where HCC is responsible for a large number of cancer deaths (El-Serag et al., 2003¬).
The etiology of HCC is multifactorial. The most important factors are cirrhosis or chronic hepatitis caused by hepatitis C or hepatitis B infections, and alcohol. Hepatocellular carcinoma usually presents with nonspecific symptoms, either due to the underlying cirrhosis or HCC itself (Al-Sowmely and Hodgson, 2002).
Unfortunately, HCC is often diagnosed only at an advanced stage due to the absence of specific symptoms during the initial course of the disease (Llovet and Bruix, 2003).
Unlike other forms of cancer, the diagnosis of HCC does not always require histological confirmation and HCC is usually diagnosed by tumor marker and radiology such as ultra-sonography, C.T and MRI. (Bolondi et al., 2005).
The usual outcome is poor, because only 10-20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually deadly within 3-6 months, although this varies greatly. Survival much longer than this occasionally occurs.
Hepatocellular carcinoma has, thus far, proven to be a difficult target for systemic therapies. The mainstays of treatment are, thus, physical treatments that in one way or another directly attack the tumor or its blood supply. The additional challenge posed by the fact that most cases of HCC develop in the setting of cirrhosis with impaired liver function, makes the selection of treatment a science in itself (Bruix and Sherman, 2005).
Till date, surgical, percutaneous and trans-arterial interventions have not been compared in randomized controlled trials. Tumor resection and transplantation can achieve a 5-year survival rate of 60-70% in selected patients. Transplantation is the best treatment for patients with single lesions and advanced liver diseases, such as decompensated cirrhosis and multicentric small tumors (Blum, 2005).
Unfortunately, the overall 5-year survival rate for all patients with HCC has remained steady at 3-5% (Parkin et al., 2005).