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The importance of a multidisciplinary approach to hepatocellular carcinoma

Authors Siddique O, Yoo ER, Perumpail RB, Perumpail BJ, Liu A, Cholankeril G, Ahmed A

Received 24 November 2016

Accepted for publication 23 February 2017

Published 20 March 2017 Volume 2017:10 Pages 95—100

DOI https://doi.org/10.2147/JMDH.S128629

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Osama Siddique,1 Eric R Yoo,2 Ryan B Perumpail,3 Brandon J Perumpail,4 Andy Liu,5 George Cholankeril,6 Aijaz Ahmed3

1Department of Medicine, Brown University, Providence, RI, 2Department of Medicine, University of Illinois College of Medicine, Chicago, IL, 3Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 4Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, 5Department of Medicine, California Pacific Medical Center, San Francisco, CA, 6Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA

Abstract: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners. In most cases, HCC is diagnosed by abdominal imaging studies, preferably with a triphasic computed tomography scan of the abdomen or magnetic resonance imaging of the abdomen. Histopathological diagnosis using a guided liver biopsy may be needed in noncirrhotic patients or when radiological diagnostic criteria are not fulfilled in the setting of cirrhosis. The Barcelona Clinic Liver Cancer staging system facilitates a standardized therapeutic strategy based on the tumor burden, extent of metastasis, severity of hepatic decompensation, comorbid medical illnesses, functional status of patient, HCC-related symptoms, and preference of the patient. Treatment options include curative surgery (hepatic resection and liver transplantation) and palliative measures (radiofrequency ablation, transarterial chemoembolization, and chemotherapy with sorafenib). The role of the multidisciplinary team is crucial in promptly reconfirming the diagnosis, staging the HCC, and formulating an individualized treatment plan. In potential liver transplant candidates, timely liver transplant evaluation and coordinating bridging/downsizing treatment modalities, such as radiofrequency ablation and transarterial chemoembolization, can be time-consuming. In summary, a multidisciplinary team approach provides a timely, individualized treatment plan, which can vary from curative surgery in patients with early-stage HCC to palliative/hospice care in patients with metastatic HCC. In most tertiary care centers in the US, a multidisciplinary liver tumor board has become the standard of care and a key component of best practice protocol for patients with HCC.

Keywords: multidisciplinary team, MDT, hepatocellular carcinoma, HCC

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Hepatic encephalopathy: what the multidisciplinary team can do

Liu A, Yoo ER, Siddique O, Perumpail RB, Cholankeril G, Ahmed A

Journal of Multidisciplinary Healthcare 2017, 10:113-119

Published Date: 24 March 2017