NEW MODALITIES IN MANAGEMENT OF HEPATOMA

Abstract

Most of the progress in surgery of the liver has occure<;i in the last three decades. For centuries, the liver was regarded as a mysterious organ with complex anatomy, an overwhelming number of functions, and an extraoridnary capability to regenerate. The organ's large size and abundant blood supply contributed to the respect paid to this organ in most civilizations and operating theatres. Improved understanding of anatomy and physiology, combined with a number of recently developed surgical techniques, has led to the emergence of the specialty of hepatobiliary surgery. Primary liver cancer (HCC) is one of the world's commonest cancer and its incidence is expected to rise rapidly .. over the next decade. This rise is due to the association with chronic liver disease particularly HBV and HCV. Owing to this association many patients, who are known to have chronic liver disease, are being screened for the development of HCC by serial ultrasound scans of the liver and serum measurements of alfafetoprotein. The use of tumor markers and immuno-scintigraphy for detection, and the application of refined imaging techniques in the form of color doppler flow imaging, <;iynamic contrast enhanced CT., multisection FLASH M.R. Imaging of the liver, magnetization transfer of hepatic lesions, ultrasound­ angiography and guided biopsy have increased the chance of detection of early or small HCC. The diagnostic modalities have to work in conjunction with each other to properly diagnose the disease.