EASL–EORTC Clinical Practice Guidelines (CPG) on the management of hepatocellular carcinoma (HCC) define the use of surveillance, diagnosis, and therapeutic strategies recommended for patients with this type of cancer. This is the first European joint effort by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) to provide common guidelines for the management of hepatocellular carcinoma. These guidelines update the recommendations reported by the EASL panel of experts in HCC published in 2001 [1]. Several clinical and scientific advances have occurred during the past decade and, thus, a modern version of the document is urgently needed. The purpose of this document is to assist physicians, patients, health-care providers, and health-policy makers from Europe and worldwide in the decision-making process according to evidencebased data. Users of these guidelines should be aware that the recommendations are intended to guide clinical practice in circumstances where all possible resources and therapies are available. Thus, they should adapt the recommendations to their local regulations and/or team capacities, infrastructure, and cost– benefit strategies. Finally, this document sets out some recommendations that should be instrumental in advancing the research and knowledge of this disease and ultimately contribute to improve patient care. The EASL–EORTC CPG on the management of hepatocellular carcinoma provide recommendations based on the level of evidence and the strength of the data (the classification of evidence is adapted from National Cancer Institute [2]) (Table 1A) and the strength of recommendations following previously reported systems (GRADE systems) (Table 1B).

http://www.bclc.cat/download/easl-guidelines.pdf

EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma European Association for the Study of the Liver ⇑ , European Organisation for Research and Treatment of Cancer

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60439-5.pdf

Wilson's Disease

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jhep.2003.50252

A practice guideline on Wilson disease

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.

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

/pdf/guidelines-for-the-diagnosis-and-treatment-of-hepatocellular-1tgeinic2v.pdf

Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults

EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma

A 33-year-old man with Wilson's disease developed hemoptysis and radiographic evidence of nodular pulmonary infiltrates. A premortem diagnosis of hepatocellular carcinoma was made on the basis of alpha-naphthylannidase stains of pulmonary tissue obtained by open lung biopsy. We review all previous cases of Wilson's disease with this unusual complication and discuss the role of copper in hepatic oncogenesis as well as the alpha-naphthylannidase stain for the diagnosis of hepatocellular carcinoma.

Alice Chow

Papers

Hepatocellular Carcinoma in Wilson's Disease Case Report and Review of the Literature