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Patients with hepatocellular carcinoma (HCC) who are cirrhotic can be more challenging, according to Adam C. Yopp, MD. The decision of whether or not to operate must be balanced with an understanding of underlying liver function and tumor characteristics, he explains. He encourages the use of a multidisciplinary forums to discuss and plan treatment for these patients.
For interventional radiology, cirrhosis is also a challenge, but not as much as for surgery, according to Jeff Gerschwind, MD. The big difference, he notes, is that interventional radiologists do not cure patients, they only palliate them. While performance status is the most significant determinant of whether there is a role for interventional radiology, normalizing the cirrhosis and the level of liver function is a key component of the decision-making process.
From the medical oncology standpoint, Richard Finn, MD states, HCC is really 2 diseases and 2 competing risks for outcomes: there is the liver disease and there is the oncologic anatomic malignancy. Unlike other malignancies, such as breast cancer and colon cancer, where patients are generally healthy with healthy organs, in the case of HCC, he notes, 90% of the patients have some degree of liver dysfunction, and liver function always has to come into play when determining the most appropriate treatments. Using a scoring system such as the Child-Pugh score, a patient with very bad liver disease and Child-Pugh C cirrhosis may not receive significant survival benefit from treatments, regardless of their HCC tumor, notes Finn.