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Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults
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  1. S D Ryder
  1. Queens Medical Centre, Nottingham NG7 2UH, UK
  1. Correspondence to:
    Dr S D Ryder;
    stephen.ryder{at}mail.qmcuh-tr.trent.nhs.uk

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1.0 FOREWORD

This document, on the diagnosis and treatment of patients with hepatocellular carcinoma (HCC), was commissioned by the British Society of Gastroenterology as part of a wider initiative to develop guidelines for clinicians in several areas of clinical practice.

Cancer care has been the subject of increased scrutiny, with the development of care guidelines forming a major part of the strategy to reduce cancer related mortality in the UK. There is a strong suggestion that HCC is a disease which will be seen more frequently over the next few years, mainly as a result of the hepatitis C virus (HCV) epidemic. Previously, HCC has been a relatively rare tumour in the UK and much of the data pertaining to its diagnosis and therapy are derived from studies outside of the UK. Because of the lack of screening programmes and the fact that a significant proportion of HCC presents as symptomatic disease in individuals not known to have liver disease, most non-surgical therapies have been used in patients with advanced disease. There are a significant number of variables known to influence prognosis, with stage of underlying liver disease and tumour size at presentation being the most important. Controlling for these variables is difficult and these factors have contributed to a dearth of randomised controlled trials of treatment for this tumour. There is however a substantial amount of evidence available which can form the basis of a framework for diagnosis and management.

Guidelines are not rigid protocols and they should not be construed as interfering with local clinical judgement. Hence they do not represent a directive of proscribed routes but a basis on which clinicians can consider the options available more clearly.

2.0 INTRODUCTION AND OBJECTIVES

These guidelines cover two areas of clinical practice relating to HCC: firstly, its diagnosis, including surveillance of high risk individuals; and …

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