f) Transarterial chemoembolization (TACE) involves selective intra-arterial administration of chemotherapeutic agents followed by embolization of the major tumor artery. Hepatocellular carcinoma Hepatocellular carcinoma preferentially derives its blood supply from the hepatic artery rather than from a combination of the hepatic artery and portal vein as for normal hepatic parenchyma. TACE has a survival benefit for select patients with unresectable tumors, Child class A cirrhosis, and tumors less than 5 cm. The procedure rarely may be complicated by hepatic failure due to infarction of adjacent normal liver. For this reason, it should not be used in decompensated (Child class C) cirrhosis.
g) An emerging therapy is local radiation therapy with yttrium-90, a beta-particle-emitting radioisotope. Yttrium-90 microspheres are selectively injected into the hepatic artery or one of its branches, causing tumor destruction through a combination of radiation and embolization.
Without treatment, Hepatocellular carcinoma has a very poor prognosis, with a median length of survival of 3 to 6 months after the diagnosis.
Fibrolamellar hepatocellular carcinoma (FLC) is a rare histologic variant of Hepatocellular carcinoma Hepatocellular carcinoma. However, there is considerable evidence that FLC is distinct from Hepatocellular carcinoma in its epidemiology, biology, and prognosis. Males and females are equally affected, commonly at a younger age (20 to 40 years old). It is uncommon for FLC to be associated with underlying liver disease such as cirrhosis. FLC is best treated with complete surgical resection, which is possible in 80% of patients. Compared with standard Hepatocellular carcinoma Hepatocellular carcinoma, FLC is associated with a better prognosis: Patients with resectable FLC have a greater 5-year survival rate (>70%) than noncirrhotic patients who have resectable nonfibrolamellar Hepatocellular carcinoma. Late recurrence is common (more than two thirds of cases), and repeat resection of local disease should be considered (Cancer 2006;106:1331). Liver transplantation is an option for unresectable but nonmetastatic lesions.