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Title: Patients at Risk for Liver Cancer Should Be Screened With Ultrasound: Presented at ASCO-GI

"Patients at Risk for Liver Cancer Should Be Screened With Ultrasound: Presented at ASCO-GI"

By Ed Susman ORLANDO, FL -- January 27, 2008 -- As the numbers of people in the United States who are at risk of hepatocellular cancer increase, more screening and surveillance of these at-risk populations are required, researchers say. "For patients at high risk of hepatocellular cancer, screening and surveillance with ultrasound should be conducted every 6 months," said Eugene Schiff, MD, Leonard Miller Professor of Medicine, Chief, Division of Hepatology, and Director, Center for Liver Diseases, University of Miami School of Medicine, Miami, Florida. In his plenary address here on January 26 at the American Society of Clinical Oncology's 2008 Gastrointestinal Cancers Symposium (ASCO-GI), Dr. Schiff said, "Hepatocellular carcinoma is becoming more common in patients with liver disease. Active hepatitis C virus infection with or without alcohol use accounts for most of the hepatocellular carcinoma in the United States." The symposium is cosponsored by ASCO with the American Gastroenterological Association Institute, the American Society for Therapeutic Radiology and Oncology, and the Society for Surgical Oncology. Dr. Schiff said that cases of liver cancer in the United States have increased 7-fold since 1998. He added that the at-risk population includes the following groups: - Patients infected with hepatitis C virus, especially if that patient has already developed signs of cirrhosis - Patients infected with hepatitis B virus, even if the patient has no signs of cirrhosis and especially if that patient was born and raised in areas such as Africa and Asia, where hepatitis B virus is endemic - Patients who consume large amounts of alcohol, which contributes to cirrhosis - Patients who have other risk factors such as hemochromatosis or nonalcoholic fatty liver disease Use of alpha fetoprotein (AFP) as a screening tool is controversial because it has a low positive predictive value and a very low negative predictive value, Dr. Schiff said. Patients with AFP levels higher than 200 ng/mL have about a 67% risk of having hepatocellular carcinoma, but only about 5% of patients with hepatocellular cancer are likely to have advanced disease. While ultrasound can be utilized as a screening tool, computed tomography (CT) scans can be used to visualize more clearly the arterial system involved, and T2 magnetic resonance imaging (MRI) will also improve visualization of the tumor. He said the use of CT and MRI are likely to help define tumors that are found with ultrasound, but are too expensive to be used as screening devices. Dr. Schiff said liver biopsies for most patients are not necessary, especially if masses are seen in patients with a history of cirrhosis. Liver biopsies are also prone to cause hemorrhage. [[Presentation title: Identifying High-Risk Populations for Hepatocellular Carcinoma: What Is the Standard for Screening? Plenary Address]

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