MediFocus Guidebook

Liver Cancer

Last Update: 21 Jun 2007

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How To Use This Medifocus Guidebook

MediFocus Guidebook Organization and Content

Before you start to review your Guidebook, it would be helpful to familiarize yourself with the organization
and content of the information that is included in the Guidebook. Your MediFocus Guidebook is organized
into the following five major sections.

• Section 1: Background Information - This section provides detailed information about the

organization and content of the Guidebook including tips and suggestions for conducting additional
research about the condition.

• Section 2: The Intelligent Patient Overview - This section is a comprehensive overview of the

condition and includes important information about the cause of the disease, signs and symptoms,
how the condition is diagnosed, the treatment options, quality of life issues, and questions to ask your
doctor.

• Section 3: Guide to the Medical Literature - This section opens the door to the latest cutting-edge

research and clinical advances recently published in leading medical journals. It consists of an
extensive, focused selection of journal article references with links to the PubMed® abstracts
(summaries) of the articles. PubMed® is the U.S. National Library of Medicine's database of
references and abstracts from more than 4,500 medical and scientific articles published worldwide.

• Section 4: Centers of Research - This section is a unique directory of doctors, researchers, hospitals,

medical centers, and research institutions with specialized interest and, in many cases, clinical
expertise in the management of patients with the condition. You can use the "Centers of Research"
directory to contact, consults, or network with leading experts in the field and to locate a hospital or
medical center that can help you.

• Section 5: Tips for Finding and Choosing a Doctor - This section of your Guidebook offers

important tips for how to find physicians as well as suggestions for how to make informed choices
about choosing a doctor who is right for you.

• Section 6: Directory of Organizations - This section of your Guidebook is a directory of select

disease organizations and support groups that are in the business of helping patients and their families
by providing access to information, resources, and services. Many of these organizations can answer
your questions, enable you to network with other patients, and help you find a doctor in your
geographical area who specializes in managing your condition.

MediFocus Guidebook Formats

This MediFocus Guidebook is available in both an electronic format as well as a printed format. The
electronic and printed formats follow the same basic outline with respect to organization and content of the
various sections. The primary difference between the two formats pertains to the method of accessing the
PubMed® abstracts (summaries) of the journal article references in the "The Guide to the Medical
Literature" section (Section 3) of the Guidebook.

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• Electronic Format - You can easily access the PubMed® abstracts of the journal article references by

simply clicking on the "Abstract URL" link for the corresponding article.

• Printed Format - If you purchased the printed format of this MediFocus Guidebook, you have two

options for accessing the PubMed® abstracts of the journal article references in Section 3 of the
Guidebook:

• Manually type in the "Abstract URL" information for a specific article directly into your

computer's browser (e.g., Internet Explorer, Netscape) and you will be directed to the PubMed®
abstract of the article.

• Use the electronic format of your Guidebook to access the journal article abstracts. When you

purchased the printed copy of this Guidebook, you were also provided free online access to the
electronic format of the same Guidebook for one year. You can easily access the PubMed®
abstracts of the journal article references by simply clicking on the "Abstract URL" link for the
corresponding article.

How to Access the Electronic Format of Your Guidebook

You can easily access the online electronic format of your Guidebook by following these easy instructions:

• Visit our web site at

http://www.medifocus.com

• Click on the "Support" tab at the upper right corner of the page

• Enter your "Order Number"

• Enter your "Password"

• Click on the "Submit" button

What if You Don't Own a Computer?

If you don't own a computer, you may wish to ask a relative or friend with a computer to help you access
the electronic Guidebook. They will be able to access the online electronic format of the Guidebook for you
by simply following the instructions outlined above.

Contact Us

If you forgot your "Order Number" or "Password", please contact us and we will be happy to retrieve the
information for you:

• Toll Free: 1-800-965-3002
• From outside the U.S.: 1-301-649-9300
• E-mail: info@medifocus.com

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How to Access Updates of Your Guidebook

With your initial purchase of this MediFocus Guidebook, you also have online access to updates of the
Guidebook for one full year free of charge. MediFocus Guidebooks are updated with new information every
4 months so that you can stay current with the latest developments about your condition. Shortly after the
Guidebook has been updated, we post the latest updated version (with the new date) on our web site. We
invite you to visit our web site every one or two months to check if an updated version of your Guidebook
has been posted since your last visit.

Follow these easy instructions to check the latest update for your Guidebook:

• Visit our web site at

http://www.medifocus.com

• On the left side of the Home page you will see a listing of the "Diseases and Conditions"

• Click on the name of the disease or condition of your Guidebook.

• The latest date of revision (update) of your Guidebook is posted within the blue box just below the

image of the Guidebook.

You can easily access the updates online with the electronic format of your Guidebook by following these
simple instructions:

• Visit our web site at

http://www.medifocus.com

• Click on the "Support" tab at the upper right corner of the page

• Enter your "Order Number"

• Enter your "Password"

• Click on the "Submit" button

What if You Don't Own a Computer?

If you don't own a computer, you may wish to ask a relative or friend with a computer to help you access
the electronic Guidebook. They will be able to access the online electronic format of the Guidebook for you
by simply following the instructions outlined above.

Contact Us

If you forgot your "Order Number" or "Password", please contact us and we will be happy to retrieve the
information for you:

• Toll Free: 1-800-965-3002

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• From outside the U.S.: 1-301-649-9300
• E-mail: info@medifocus.com

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Disclaimer

Medifocus.com, Inc. serves only as a clearinghouse for medical health information and does not directly or
indirectly practice medicine. Any information provided by Medifocus.com, Inc. is intended solely for
educating our clients and should not be construed as medical advice or guidance, which should always be
obtained from a licensed physician or other health-care professional. As such, the client assumes full
responsibility for the appropriate use of the medical and health information contained in the Guidebook and
agrees to hold Medifocus.com, Inc. and any of its third-party providers harmless from any and all claims or
actions arising from the clients' use or reliance on the information contained in this Guidebook. Although
Medifocus.com, Inc. makes every reasonable attempt to conduct a thorough search of the published medical
literature, the possibility always exists that some significant articles may be missed.

Copyright

© Copyright 2006, Medifocus.com, Inc. All rights reserved as to the selection, arrangement, formatting, and
presentation of the information contained in this report, including our background and introductory
information.

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Table of Contents

Background Information

...................................................................................................... 8

Introduction ...................................................................................................................................... 8
About Your Medifocus Guide .......................................................................................................... 9
Ordering Full-Text Articles ............................................................................................................ 12

The Intelligent Patient Overview

.................................................................................. 14

Guide to the Medical Literature

.................................................................................... 47

Introduction .................................................................................................................................... 47
Recent Literature: What Your Doctor Reads ................................................................................ 48

Review Articles .......................................................................................................................... 48
General Interest Articles ............................................................................................................ 53
Drug Therapy ............................................................................................................................. 60
Surgical Therapy ........................................................................................................................ 62
Clinical Trials ............................................................................................................................. 67
Radiation Therapy ...................................................................................................................... 77
Liver Transplantation ................................................................................................................. 79
Radiofrequency Ablation ........................................................................................................... 81
Arterial Embolization ................................................................................................................. 83

Centers of Research

............................................................................................................... 86

United States ................................................................................................................................... 87
Other Countries ............................................................................................................................... 91

Tips on Finding and Choosing a Doctor

................................................................. 103

Directory of Organizations

.............................................................................................. 108

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1 - Background Information

Introduction

Chronic or life-threatening illnesses can have a devastating impact on both the patient and the family. In
today's new world of medicine, many consumers have come to realize that they are the ones who are
primarily responsible for their own health care as well as for the health care of their loved ones.

When facing a chronic or life-threatening illness, you need to become an educated consumer in order to
make an informed health care decision. Essentially that means finding out everything about the illness - the
treatment options, the doctors, and the hospitals - so that you can become an educated health care consumer
and make the tough decisions. In the past, consumers would go to a library and read everything available
about a particular illness or medical condition. In today's world, many turn to the Internet for their medical
information needs.

The first sites visited are usually the well known health "portals" or disease organizations and support
groups which contain a general overview of the condition for the layperson. That's a good start but soon all
of the basic information is exhausted and the need for more advanced information still exists. What are the
latest "cutting-edge" treatment options? What are the results of the most up-to-date clinical trials? Who are
the most notable experts? Where are the top-ranked medical institutions and hospitals?

The best source for authoritative medical information in the United States is the National Library of
Medicine's medical database called PubMed®, that indexes citations and abstracts (brief summaries) of over
7 million articles from more than 3,800 medical journals published worldwide. PubMed® was developed
for medical professionals and is the primary source utilized by health care providers for keeping up with the
latest advances in clinical medicine.

A typical PubMed® search for a specific disease or condition, however, usually retrieves hundreds or even
thousands of "hits" of journal article citations. That's an avalanche of information that needs to be evaluated
and transformed into truly useful knowledge. What are the most relevant journal articles? Which ones apply
to your specific situation? Which articles are considered to be the most authoritative - the ones your
physician would rely on in making clinical decisions? This is where Medifocus.com provides an effective
solution.

Medifocus.com has developed an extensive library of MediFocus Guidebooks covering a wide spectrum of
chronic and life threatening diseases. Each MediFocus Guidebook is a high quality, up- to-date digest of
"professional-level" medical information consisting of the most relevant citations and abstracts of journal
articles published in authoritative, trustworthy medical journals. This information represents the latest
advances known to modern medicine for the treatment and management of the condition, including
published results from clinical trials. Each Guidebook also includes a valuable index of leading authors and
medical institutions as well as a directory of disease organizations and support groups. MediFocus
Guidebooks are reviewed, revised and updated every 4-months to ensure that you receive the latest and most
up-to-date information about the specific condition.

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About Your MediFocus Guidebook

Introduction

Your MediFocus Guidebook is a valuable resource that represents a comprehensive synthesis of the most
up-to-date, advanced medical information published about the condition in well-respected, trustworthy
medical journals. It is the same type of professional-level information used by physicians and other
health-care professionals to keep abreast of the latest developments in biomedical research and clinical
medicine. The Guidebook is intended for patients who have a need for more advanced, in-depth medical
information than is generally available to consumers from a variety of other resources. The primary goal of
a MediFocus Guidebook is to educate patients and their families about their treatment options so that they
can make informed health-care decisions and become active participants in the medical decision making
process.

The Guidebook production process involves a team of professionals with expertise in diverse areas
including experienced medical database researchers and practicing physicians who serve as members of the
Medifocus.com Medical Advisory Board (MAB). This team approach to the development and production of
the MediFocus Guidebooks is designed to ensure the accuracy, completeness, and clinical relevance of the
information. The Guidebook is intended to serve as a basis for more meaningful discussions between
patients and their health-care providers in a joint effort to seek the most appropriate course of treatment for
the disease.

Guidebook Organization and Content

Section 1 - Background Information

This section provides detailed information about the organization and content of the Guidebook including
tips and suggestions for conducting additional research about the condition.

Section 2 - The Intelligent Patient Overview

This section of your MediFocus Guidebook represents a detailed overview of the disease or condition
specifically written from the patient's perspective. It is designed to satisfy the basic informational needs of
consumers and their families who are confronted with the illness and are facing difficult choices. Important
aspects which are addressed in "The Intelligent Patient" section include:

• The etiology or cause of the disease
• Signs and symptoms
• How the condition is diagnosed
• The current standard of care for the disease
• Treatment options
• New developments
• Important questions to ask your health care provider

Section 3 - Guide to the Medical Literature

This is a roadmap to important and up-to-date medical literature published about the condition from
authoritative, trustworthy medical journals. This is the same information that is used by physicians and
researchers to keep up with the latest developments and breakthroughs in clinical medicine and biomedical
research. A broad spectrum of articles is included in each MediFocus Guidebook to provide information
about standard treatments, treatment options, new clinical developments, and advances in research. To

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facilitate your review and analysis of this information, the articles are grouped by specific categories. A
typical MediFocus Guidebook usually contains one or more of the following article groupings:

• Review Articles: Articles included in this category are broad in scope and are intended to provide the

reader with a detailed overview of the condition including such important aspects as its cause,
diagnosis, treatment, and new advances.

• General Interest Articles: These articles are broad in scope and contain supplementary information

about the condition that may be of interest to select groups of patients.

• Drug Therapy: Articles that provide information about the effectiveness of specific drugs or other

biological agents for the treatment of the condition.

• Surgical Therapy: Articles that provide information about specific surgical treatments for the

condition.

• Clinical Trials: Articles in this category summarize studies which compare the safety and efficacy of

a new, experimental treatment modality to currently available standard treatments for the condition. In
many cases, clinical trials represent the latest advances in the field and may be considered as being on
the "cutting edge" of medicine. Some of these experimental treatments may have already been
incorporated into clinical practice.

The following information is provided for each of the articles referenced in this section of your MediFocus
Guidebook:

• Article title
• Author Name(s)
• Institution where the study was done
• Journal reference (Volume, page numbers, year of publication)
• Link to Abstract (brief summary of the actual article)

Linking to Abstracts: Most of the medical journal articles referenced in this section of your MediFocus
Guidebook include an abstract (brief summary of the actual article) that can be accessed online via the
National Library of Medicine's PubMed® database. You can easily access the individual abstracts online
via PubMed® from the "electronic" format of your MediFocus Guidebook by clicking on the corresponding
URL address that is provided for each cited article. If you purchased a printed copy of a MediFocus
Guidebook, you can still access the article abstracts online by entering the individual URL address for a
particular article into your web browser.

Section 4 - Centers of Research

We've compiled a unique directory of doctors, researchers, medical centers, and research institutions with
specialized research interest, and in many cases, clinical expertise in the management of the specific
medical condition. The "Centers of Research" directory is a valuable resource for quickly identifying and
locating leading medical authorities and medical institutions within the United States and other countries
that are considered to be at the forefront in clinical research and treatment of the condition.

Inclusion of the names of specific doctors, researchers, hospitals, medical centers, or research institutions in
this MediFocus Guidebook does not imply endorsement by Medifocus.com, Inc. or any of its affiliates.
Consumers are encouraged to conduct additional research to identify health-care professionals, hospitals,

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and medical institutions with expertise in providing specific medical advice, guidance, and treatment for this
condition.

Section 5 - Tips on Finding and Choosing a Doctor

One of the most important decisions confronting patients who have been diagnosed with a serious medical
condition is finding and choosing a qualified physician who will deliver high-level, quality medical care in
accordance with curently accepted guidelines and standards of care. Finding the "best" doctor to manage
your condition, however, can be a frustrating and time-consuming experience unless you know what you are
looking for and how to go about finding it. This section of your Guidebook offers important tips for how to
find physicians as well as suggestions for how to make informed choices about choosing a doctor who is
right for you.

Section 6 - Directory of Organizations

This section of your Guidebook is a directory of select disease organizations and support groups that are in
the business of helping patients and their families by providing access to information, resources, and
services. Many of these organizations can answer your questions, enable you to network with other patients,
and help you find a doctor in your geographical area who specializes in managing your condition.

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Ordering Full-Text Articles

After reviewing your MediFocus Guidebook, you may wish to order the full-text copy of some of the
journal article citations that are referenced in the Guidebook. There are several options available for
obtaining full-text copies of journal articles, however, with the exception of obtaining the article yourself by
visiting a nearby medical library, most involve a fee to cover the costs of photocopying, delivering, and
paying the copyright royalty fees set by the individual publishers of medical journals.

This section of your MediFocus Guidebook provides some basic information about how you can go about
obtaining full-text copies of journal articles from various fee-based document delivery resources.

Commercial Document Delivery Services

There are numerous commercial document delivery companies that provide full-text photocopying and
delivery services to the general public. The costs may vary from company to company so it is worth your
while to carefully shop-around and compare prices. Some of these commercial document delivery services
enable you to order articles directly online from the company's web site. You can locate companies that
provide document delivery services by typing the key words "document delivery" into any major Internet
search engine.

National Library of Medicine's "Loansome Doc" Document
Retrieval Services

The National Library of Medicine (NLM), located in Bethesda, Maryland, offers full-text photocopying and
delivery of journal articles through its on-line service known as "Loansome Doc". To learn more about how
you can order articles using "Loansome Doc", please visit the NLM web site at:

http://www.nlm.nih.gov/pubs/factsheets/loansome_doc.html

Participating "Loansome Doc" Libraries: United States

In the United States there are approximately 250 medical libraries that participate in the National Library of
Medicine's "Loansome Doc" document retrieval and delivery services for the general public. Please note
that each participating library sets its own policies and charges for providing document retrieval services.
To order full-text copies of articles, simply contact a participating "Loansome Doc" medical library in your
geographical area and ask to speak with one of the reference librarians. They can answer all of your
questions including fees, delivery options, and turn-around time.

Here is how to find a participating "Loansome Doc" library in the U.S. that provides article retrieval
services for the general public:

• United States - Contact a Regional Medical Library at 1-800-338-7657 (Monday - Friday; 8:30 AM -

5:30 PM). They will provide information about libraries in your area with which you may establish an
account for the "Loansome Doc" service.

• Canada - Contact the Canada Institute for Scientific and Technical Information (CISTI) at

1-800-668-1222 for information about libraries in your area.

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International MEDLARS Centers

If you reside outside the United States, you can obtain copies of medical journal articles through one of
several participating International Medical Literature Analysis and Retrieval Systems (MEDLARS) Centers
that provide "Loansome Doc" services in over 20 major countries. International MEDLARS Centers can be
found in some of these countries: Australia, Canada, China, Egypt, France, Germany, Hong Kong, India,
Israel, Italy, Japan, Korea, Kuwait, Mexico, Norway, Russia, South Africa, Sweden, and the United
Kingdom. A complete listing of International MEDLARS Centers, including locations and telephone
contact information can be viewed at:

http://www.nlm.nih.gov/pubs/factsheets/intlmedlars.html

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2 - The Intelligent Patient Overview

LIVER CANCER

Introduction to Liver Cancer

The liver, which is located in the upper right corner of the abdomen, is one of the body's
most vital organs and performs many important metabolic functions that are critical for
maintaining a person's health and well-being. The liver is the largest single organ in the
human body and, in an average adult, weighs about 3 pounds. The liver is divided into two
major lobes (right and left lobes) which can be further subdivided microscopically into about
a million smaller functional units called lobules. The lobules, in turn, consist of individual
liver cells called hepatocytes.

It has been estimated that the liver performs about 500 different functions in the human
body. Some of these major functions include:

• Converting food into energy - The liver stores carbohydrates in abundant amounts of

glycogen (a form of glucose). When the body requires an energy "boost", the liver
breaks down the stored glycogen into glucose that is then released into the bloodstream
and transported to the tissues and organs where it is converted by the cells into energy.

• Production of bile - The liver produces a substance called bile which helps the body in

the process of digestion of fats.

• Detoxification (purification) of blood - The liver filters blood and helps to eliminate

waste products and toxins from the bloodstream.

• Production of cholesterol - The liver helps regulate the levels of cholesterol in the

bloodstream. Cholesterol is used by cells to form the outer membrane of cells and is
needed by cells to carry out other important functions.

• Resistance to infection The liver produces specialized immune cells called

macrophages which are critical in helping the body destroy and eliminate foreign
microorganisms (e.g., bacteria) that can cause serious, life-threatening infections.

• The liver also plays an important role in metabolism of fats and proteins which are vital

for optimal function of cells.

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Diseases of the Liver

Although there are over 100 different diseases that can affect the liver, a few of these
deserve special mention because they have been identified as risk factors for the
development of hepatocellular carcinoma - the most common type of primary liver cancer.
These liver diseases include:

• Chronic hepatitis infection - Hepatitis is an inflammation of the liver that is usually

caused by a virus. The most common types of viral hepatitis in the United States
include:

• Hepatitis A - usually contracted by eating foods or drinking water that has been

contaminated with the hepatitis A virus. Approximately 150,000 people in the
United States are infected with Hepatitis A virus each year.

• Hepatitis B - usually contracted through contaminated blood, blood products, or

sexual contact. About 1 million people in the United States are infected with
Hepatitis B virus.

• Hepatitis C - this virus is also usually contracted by coming into contact with

contaminated blood (such as sharing needles) or by sexual contact. Approximately
4 million people in the United States are infected with Hepatitis C virus.

• Cirrhosis of the liver - This condition occurs as a result of chronic liver inflammation

which causes the accumulation of fibrous scar tissue in the liver. As a consequence of
the build-up of scar tissue, the liver loses its ability to perform its vital functions that
are necessary for maintaining good overall health. Liver cirrhosis can be caused by
chronic infection with the hepatitis B or hepatitis C virus, chronic alcohol abuse, and
hemochromatosis (a genetic disorder that results in the accumulation of excess levels of
iron in the liver as well as other organs in the body)

• Alcoholic liver disease - Chronic (long-term) abuse of alcohol can lead to inflammation

of the liver that, in turn, causes liver cirrhosis and permanent liver damage.

• Liver tumors - Tumors of the liver may be grouped into those that are benign

(non-cancerous) and those that are malignant (cancerous). The most common type of
benign liver tumors are hemangiomas - tumors that originate in the blood vessels. The
most common type of primary malignant liver cancer is known as hepatocellular
carcinoma. This is a primary form of liver cancer because the cancer originates in the
liver cells (hepatocytes). Cancer that metastasizes (spreads) to the liver from another

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organ in the body where it originally started is referred to as secondary liver cancer.

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma, also called malignant hepatoma, is the most common form of primary
malignant liver cancer and originates in the hepatocyte cells of the liver. Unless otherwise
specified, the term "liver cancer" is used throughout this Guidebook to refer specifically to
hepatocellular carcinoma which represents the most common type of primary liver cancer.

Hepatocellular carcinoma (liver cancer) is the fifth most common type of cancer worldwide with
nearly 500,000 new cases diagnosed each year. Although the incidence of liver cancer is highest
in parts of Africa and Asia, increasing numbers of cases are being diagnosed in the United States,
Western Europe, and Japan. Approximately 19,000 cases of primary liver cancer are diagnosed
each year in the United States with an overall incidence of 2.4 to 3.2 cases per 100,000 people.
Hepatocellular carcinoma is the most common type of primary liver cancer in adults and
represents about 75% of all primary liver tumors. This type of liver cancer occurs much more
frequently in men than in women.

Although the exact cause of hepatocellular carcinoma is not currently known, this is one of the
few types of cancers with well-defined risk factors. A risk factor is any characteristic or activity
that increases a person's chances of developing a particular disease or disorder. The major risk
factors for hepatocellular carcinoma include:

• Cirrhosis of the liver - Approximately 80% of cases of liver cancer are diagnosed in patients

with liver cirrhosis. Since chronic alcohol abuse is a major cause of liver cirrhosis, it is also
recognized as a major risk factor for liver cancer.

• Hepatitis - Chronic infection with the Hepatitis B virus or the Hepatitis C virus increases a

person's risk for developing cirrhosis of the liver and, therefore, also increases the risk for
developing liver cancer. In the United States, infection with the Hepatitis C virus is about 3
times more common than infection with the Hepatitis B virus and, consequently, about 50%
of cases of liver cancer in the U.S. occur in patients infected with Hepatitis C.

• Exposure to aflatoxins - Aflatoxins are toxic substances produced by certain fungi (molds)

under warm humid, conditions that can contaminate crops. In some parts of the world, but
not the United States, aflatoxin crop contamination is a major problem and has been linked
to the development of liver cancer.

• Hemochromatosis - Hereditary hemochromatosis is a genetic disorder that results in the

excessive accumulation of iron in various organs of the body, including the liver, that can
result in liver cirrhosis. It has been estimated that liver cancer occurs in about 7% to 22% of

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patients with hereditary hemochromatosis who also have liver cirrhosis.

• Primary biliary cirrhosis - Primary biliary cirrhosis is a disease characterized by

inflammatory destruction of the small bile ducts within the liver. Primary biliary cirrhosis
eventually leads to cirrhosis of the liver and is, therefore, a risk factor for developing liver
cancer.

• Anabolic steroids - Athletes who use anabolic steroids (e.g., testosterone) for a long period

of time to increase muscle mass are at increased risk for developing primary liver cancer.

• Gender - In the United States, liver cancer occurs much more frequently in males than

females by a ratio of about 3 to 1.

• Age - In the United States, liver cancer occurs much more frequently in people over the age

of 60 than in younger people.

• Race - The incidence of liver cancer is about twice as high in African-Americans that in

Caucasians.

• Family history - A family history of liver cancer may be an additional risk factor for

developing this condition.

Diagnosis of Liver Cancer

Signs and Symptoms of Liver Cancer

Unfortunately, the early diagnosis of liver cancer is difficult because most people with early-stage
liver cancer are asymptomatic (do not exhibit clinical symptoms of the disease). Consequently, by
the time signs and symptoms develop, the disease has already progressed to a more advanced
stage. That's why liver cancer is sometimes referred to as a "silent" disease. The following signs
and symptoms may be present in patients with liver cancer, however, these symptoms are not
specific for liver cancer and may overlap with other conditions:

• Abdominal pain
• Generalized fatigue and weakness
• Hepatomegaly - enlargement of the liver, which is the most common finding on physical

examination in patients with liver cancer.

• Unintentional weight loss
• Poor appetite
• Early satiety - a feeling of fullness in the stomach after consuming a small meal
• Jaundice - a yellowish-green complexion of the skin and eyes caused by the accumulation of

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bilirubin in the liver.

• Fever
• Nausea and vomiting
• Splenomegaly - enlargement of the spleen

Diagnostic Testing for Liver Cancer

Physical Examination

Patients who present with symptoms suggestive of liver undergo a thorough medical history and
physical examination. During the physical exam, the doctor will carefully evaluate the patient for
the following symptoms:

• Hepatomegaly - enlargement of the liver
• Splenomegaly - enlargement of the spleen
• Ascites - abnormal accumulation of fluid in the abdomen
• Jaundice - a yellowish-green complexion of the skin and eyes caused by the accumulation of

bilirubin in the liver

Alpha-Fetoprotein

Measuring the levels of alpha-fetoprotein in the blood is the most commonly used laboratory test
for the detection of liver cancer. Patients with liver cancer often have elevated levels of
alpha-fetoprotein in their bloodstream that can be measured with a special blood test. The normal
level of alpha-fetoprotein in adults is 20 ng/ml. In general, elevated levels of alpha-fetoprotein of
400 ng/ml or higher strongly suggests the presence of liver cancer. Monitoring changes in
alpha-fetoprotein levels is also useful in helping doctors determine the effectiveness of various
treatments for liver cancer.

Diagnostic Imaging

Radiological imaging is a very useful tool for helping to establish the diagnosis of liver cancer
and also plays an important role in staging the extent of spread of the disease. Several imaging
modalities may be used for liver cancer including:

• Ultrasound - This is a non-invasive diagnostic imaging technique which uses

high-frequency sound waves to create images of blood vessels, tissues, and organs.
Ultrasound can be used to visualize a solid tumor in the liver, however, it cannot
differentiate hepatocellular carcinoma from other types of liver tumors.

• Computed tomography (CT scan) - This is a diagnostic imaging procedure that uses special

x-ray equipment to obtain cross-sectional pictures of the body. Using this technique, doctors
can obtain very detailed images of organs, bones, blood vessels, and other tissues. The CT
scan is very useful in helping doctors determine if a patient's liver tumor is hepatocellular
carcinoma or another type of solid liver tumor.

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• Magnetic resonance imaging (MRI) - This is a diagnostic imaging procedure that uses

magnetic fields and radio-waves to produce detailed images of organs and tissues. In
patients with liver tumors, MRI is very useful in helping doctors determine if the tumor is
malignant or benign.

• Angiography - This is a diagnostic imaging procedure that is performed to visualize blood

vessels after injecting them with a dye that enables the blood vessels to be seen on an X-ray.
Angiography is very useful in helping surgeons determine if the tumor in the liver is
resectable (can be surgically removed).

Liver Biopsy

In some cases, patients with suspected liver cancer may require a biopsy of the liver to confirm
the diagnosis. This procedure is usually performed for patients with symptoms suggestive of liver
cancer who either do not have elevated levels of alpha-fetoprotein in the blood or where the
diagnosis of liver cancer cannot be made on the basis of imaging studies. During a liver biopsy, a
piece of liver tissue is removed and the tissue is then examined under a microscope for the
presence of cancer cells. Various techniques can be used to perform a liver biopsy including:

• Fine needle aspiration - A very fine, thin needle is used to remove a sample of cells from

the area of the tumor.

• Core biopsy - A hollow, large-core needle is used to obtain a piece of tissue from the area of

the tumor.

• Laparoscopy - During this procedure, a biopsy of the liver is performed by inserting a small,

lighted instrument called a laparoscope or endoscope through a small incision made in the
abdomen and a piece of the liver tumor is removed.

• Laparotomy - This is an open surgical procedure in which an incision is made into the

abdominal cavity and a sample of liver tissue is removed from the area of the tumor.

Staging of Liver Cancer

Staging is a process used by doctors to determine the extent of spread of a cancerous tumor.
Staging plays an important role in determining the treatment options for many types of cancers,
including liver cancer. For example, if the results of the staging tests indicate that you have
early-stage liver cancer that is localized to a small area of the liver but the rest of the liver is not
affected by the cancer, the doctor will most likely recommend surgical resection to remove the
cancerous portion of the liver. If, on the other hand, the results of staging indicate that the cancer

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has spread throughout the liver or has metastasized (spread) to other organs in the body, this is
considered to be an advanced-stage of liver cancer that cannot be removed by surgery
(nonresectable liver cancer) and other treatment options will have to be considered.

Staging also provides useful information regarding the prognosis (chances of recovery) for
the disease. In general, patients with early-stage, localized liver cancer where the tumor can
be removed by surgery (resectable liver cancer) have a better prognosis than patients with
advanced-stage liver cancer where the tumor has spread throughout the liver or has
metastasized to other organs outside the liver.

Although well-defined and generally accepted staging systems exist for most types of
cancers, unfortunately, this is not the case for hepatocellular carcinoma. Because of wide
variations of the tumor characteristics and liver function among patients with liver cancer,
currently there is no single staging system for liver cancer that is universally accepted and
used by doctors around the world. Of the various staging systems that have been developed
for hepatocellular carcinoma, the Child-Pugh Staging (CPS) system is, perhaps, the one that
is used most frequently. The CPS system evaluates the extent of liver damage (residual liver
function) in patients with cirrhosis of the liver by measuring five different factors:

• Serum bilirubin levels
• Serum albumin levels
• Prothrombin time - a test used to measure how long it takes for blood to clot.
• Presence of ascites - abnormal accumulation of fluid in the abdomen
• the presence of hepatic encephalopathy - This condition refers to damage to the central

nervous system (brain and spinal cord) that occurs in some patients with liver failure.
Symptoms include changes in consciousness which can range from mild (e.g.,
confusion) to severe (e.g., coma).

Based on the results of the CPS staging system scores, patients with liver cancer are grouped
into one of the following risk categories:

• Class A - low risk group
• Class B - intermediate risk group
• Class C - high risk group

In general, the prognosis for patients in the CPS Class A group is better than for patients in
either the CPS Class B or CPS Class C groups.

Treatment Options for Liver Cancer

The treatment options for patients with liver cancer are influenced by a variety of factors
including the stage of the disease, location of the tumor, and how well the liver is

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functioning (residual liver function). In general, the treatment options for liver cancer can be
grouped into those treatments that are considered as curative versus those that are
considered as palliative.

As implied by its name, a curative treatment is any type of treatment where the goal is to
cure the underlying disease or condition. Currently, the only curative treatments available
for liver cancer are surgical resection by partial hepatectomy (the cancerous segment of the
liver is surgically removed) and liver transplantation. In contrast, any treatment that is
designed to control the symptoms of the disease but does not cure the underlying cause of
the disease is known as a palliative treatment. Palliative treatments are usually reserved for
patients with advanced-stage liver cancer.

Curative Treatments for Liver Cancer

Currently, there are two curative treatments for liver cancer:

• Surgical resection
• Liver transplantation

Surgical Resection

Surgical resection by partial hepatectomy is the treatment of choice for most patients with
localized, resectable liver cancer where the cancer is confined to the liver and there is no
evidence of metastases to the lymph nodes or other areas of the body. Unfortunately, since
most patients with liver cancer already have advanced-stage disease at the time when they
are diagnosed, surgical resection is only an option for about 30% of patients who are
diagnosed with localized, resectable liver cancer.

During a partial hepatectomy, the surgeon removes either a segment of the liver that
contains the tumor or an entire lobe of the liver. In a healthy liver, up to 80% of the organ
can be surgically removed and the remaining healthy liver tissue will regenerate (produce
more healthy liver tissue) and be capable of performing the vital liver functions necessary to
sustain life. Patients with advanced liver cirrhosis are not considered good candidates for
surgical resection because their diseased liver cannot regenerate healthy liver tissue
following surgery.

Although surgical resection is considered as a curative treatment for liver cancer, the
long-term prognosis following this treatment modality is dependent upon a number of
factors including:

• Size of the tumor - In general, the prognosis is better for smaller tumors (less than 5.0

cm) than for larger tumors.

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• Degree of liver cirrhosis - In general, the prognosis is better for patients who do not

have liver cirrhosis than for those with extensive liver cirrhosis.

• Extent of residual liver function - In general, patients with poor residual liver function

have a worse prognosis than those with good residual liver function.

Improvements in surgical techniques for partial hepatectomy have reduced the incidence of
life-threatening complications, with most major cancer centers reporting an operative
mortality rate of less than 5%. In general, 5-year survival rates for patients with localized,
resectable liver cancer have been reported to range from 30% to 70%.

Liver Transplantation

Liver transplantation is also considered to be a curative treatment for liver cancer. This
involves surgically removing the patient's entire liver (total hepatectomy) and replacing it
with a healthy liver from a cadaveric (non-living) donor. A major drawback of liver
transplantation is finding a transplant donor and patients with liver cancer who are eligible
candidates for liver transplantation often have to wait for a significant period of time before
a donor liver can be found.

Unfortunately, liver transplantation is a treatment option for only a small proportion of
patients with liver cancer. In general, liver transplantation is most likely to be successful in
patients with liver cancer who meet the following criteria:

• Have a liver tumor smaller than 5.0 cm
• Have up to three liver tumors smaller than 3.0 cm
• Have no significant portal hypertension (high blood pressure in the portal vein that

carries blood to the liver)

• Have no evidence of spread of the tumor to lymph nodes or other areas of the body

The likelihood for a successful outcome is increased if liver transplantation is performed
within 6-months following diagnosis of liver cancer. Unfortunately, due to the shortage of
cadaveric donors, many patients with liver cancer have to wait up to 12-months or longer
before a donor liver can be found. It has been estimated that in the United States about
18,000 patients are waiting for a cadaveric liver donor transplant, whereas, the actual
number of donors available is only about 5,000. Since 1998, the United Network for Organ
Sharing (UNOS) has established a priority scoring system for allocating cadaveric livers to
patients with liver cancer based on the severity of their liver disease. More information
about UNOS can be found at

http://www.unos.org/

In order to prevent further progression of the tumor for those patients who are awaiting a
liver transplant, a variety of palliative treatments may be used including radiofrequency
ablation, percutaneous ethanol injection, and chemotherapy.

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Living donor liver transplantation, as an alternative to cadaveric liver transplants, is
currently being explored as a treatment option at some transplant centers around the world.
In this procedure, a portion of a living donor's healthy liver is surgically removed and is
transplanted into the recipient whose diseased liver has been removed by a complete
hepatectomy. Currently, only about 3,000 living donor liver transplants have been performed
worldwide and the long-term impact on survival has not yet been well established.

Palliative Treatments for Liver Cancer

A variety of palliative treatments are available for patients with localized, unresectable liver
cancer that cannot be removed surgically due to either the location of the tumor within the
liver, poor liver function, or other underlying health problems. The term "localized" refers to
the confinement of the cancer to the area of the liver without evidence of spread to the
lymph nodes or other areas of the body. As mentioned previously, palliative treatments for
liver cancer are not curative but rather are intended to control the disease and prevent further
progression, thereby, prolonging survival.

Palliative treatments for liver cancer include:

• Radiofrequency thermal ablation
• Percutaneous ethanol injection
• Cryosurgery
• Hepatic arterial embolization
• Systemic chemotherapy
• Hormonal therapy
• Radiation therapy

Radiofrequency Thermal Ablation

Radiofrequency thermal ablation is a technique that is used to destroy the tumor with
high-energy radiofrequency waves. During this procedure, the surgeon inserts a special
probe called a radiofrequency electrode directly into the tumor with the assistance of
imaging guidance such as ultrasound, CT, or MRI. Various surgical techniques can be used
to insert the electrode into the tumor including percutaneously (through the skin),
laparoscopically, or by performing a laparotomy (creating an open incision into the
abdomen). Once the probe has been placed into the tumor, radiofrequency energy is applied
that heats up the electrode and causes destruction of the tumor. In general, radiofrequency
thermal ablation is used for the treatment of localized, unresectable nodular-type liver
tumors that are 3.0 to 5.0 cm in size. Complications of this technique, which may develop in
less than 10% of patients, include fever, pain, irregular heart beats, bleeding, and formation
of liver abscess.

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Percutaneous Ethanol Injection

Another commonly used technique used for treating patients with localized, unresectable
liver cancer is called percutaneous ethanol injection (PEI). In this technique, the surgeon
uses ultrasound guidance to insert a small needle into the tumor and then injects absolute
ethanol directly into the tumor to destroy the cancer cells. Multiple treatments (usually 4 to 8
sessions) are required to shrink the liver tumor and the procedure is repeated once or twice
weekly. This procedure is performed on an outpatient basis under local anesthesia. In
general, PEI is useful for the treatment of smaller (3.0 cm or less) nodular liver cancer
tumors and is usually recommended for patients with three or fewer tumors. The most
common side-effects of PEI are fever and pain which usually resolve within a few days after
the procedure. The estimated 5-year survival rate for PEI has been reported to range from
30% to 60%.

Cryosurgery

Another technique that is sometimes used to destroy liver tumors is known as cryosurgery.
This procedure involves placing a probe containing liquid nitrogen into the tumor and
destroying the cancer cells by exposing them to freezing temperatures. Potential
complications of cryosurgery include hypothermia (low body temperature), bleeding,
irregular heart beats, kidney failure, and bile duct injury.

Hepatic Arterial Embolization

This is one of the most widely used palliative treatments for patients with localized,
unresectable liver cancer. The basic goal of hepatic arterial embolization is to deprive the
tumor of its blood supply by embolization (occlusion) of the hepatic artery which supplies
blood to the tumor. Once the blood supply to the tumor has been cut-off, the cancer cells die
and the tumor shrinks.

In performing this procedure, the surgeon inserts a tube called a catheter into the hepatic
artery and then injects tiny gelatin particles into the artery to block the flow of blood. In
some cases, anticancer drugs, such as doxorubicin, mitomicin C, or cisplatin, may also be
injected into the hepatic artery along with the gelatin particles. This type of localized cancer
treatment is known as chemoembolization and results in very high local concentrations of
anticancer drugs at the tumor site for a prolonged period of time. Although hepatic arterial
embolization, with or without chemotherapy, is not a curative treatment for liver cancer, it
does confer benefits by slowing down the rate of tumor progression and, thereby, prolonging
survival. Because patients with poor liver function cannot eliminate (detoxify) the high
concentrations of anticancer drugs that are used during chemoembolization, this treatment
modality is usually restricted to patients with adequate residual liver function.

Systemic Chemotherapy

Some patients with advanced-stage liver cancer, where the cancer has spread throughout the
liver or to other parts of the body, receive systemic chemotherapy with anticancer drugs in
an attempt to slow the progression of the disease and prolong survival. Unfortunately, liver

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cancer does not respond well to most forms of standard systemic chemotherapy. Because
many patients with advanced-stage liver cancer also have extensive liver cirrhosis and poor
residual liver function, the use of systemic chemotherapy in these patients is even more
challenging and problematic.

The anticancer drug that is most widely used as systemic chemotherapy for liver cancer is
doxorubicin (Adriamycin). Combination chemotherapy with several different drugs may
also be used. Some of the drugs that may be used in combination chemotherapy include
doxorubicin, cisplatin, 5-fluorouracil, and tegafur.

In general, most studies have not demonstrated an improvement in survival rates with either
single-agent or combination chemotherapy in patients with advanced-stage liver cancer.

Side-Effects of Chemotherapy

A drawback of chemotherapy for the treatment of cancer is that it can produce a variety of
undesired side-effects. The side-effects of chemotherapy vary depending upon the type of
drug(s) used, the dosage, and the length of time that the chemotherapy is administered. In
general, common side-effects of cancer chemotherapy may include:

• Hair loss
• Mucositis - Inflammation of the lining of the mouth and gastrointestinal tract, which

can be very painful.

• Increased susceptibility to infections
• Increased susceptibility to bleeding and bruising
• Fatigue and general feeling of weakness
• Nausea and vomiting
• Loss of appetite

The side-effects of cancer chemotherapy are temporary and usually disappear after treatment
has been completed. A variety of strategies are available to better control the side-effects of
chemotherapy and patients should discuss with their oncologist the various options that can
be used to minimize or reduce these adverse side-effects.

Hormonal Therapy

The presence of hormone receptors on the surface of cancer cells in some patients with
advanced-stage liver cancer provided the rationale for attempting to use anti-hormonal
therapy to slow the progression of the disease. Tamoxifen hormonal therapy has been used
successfully for the treatment of some types of breast cancer (estrogen-receptor positive
breast cancer). Unfortunately, clinical trials of tamoxifen for the treatment of advanced-stage
liver cancer have been disappointing and have not shown a benefit in terms of increasing
survival. Other forms of hormonal therapy, including a variety of antiandrogens and
aromatose inhibitors (eg., anastrozole) are currently being investigated.

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Radiation Therapy

External beam radiation therapy uses high-energy beams of radiation from a special
machine called a linear accelerator to direct radiation to a tumor. External beam radiation
therapy may sometimes be used as a means of alleviating pain in patients with liver cancer
but is rarely used as a primary mode of treatment for liver cancer. In some cases, doctors
may inject a radioactive isotope directly into the hepatic artery (the primary blood supply to
liver tumors) in an attempt to shrink the tumor. This form of radiation therapy is called local
radiation therapy. Once injected into the hepatic artery, the radioactive isotope is
transported via the bloodstream to the site of the liver tumor where it emits high doses of
energy to kill the cancer cells. The most common radioactive isotopes used for local
radiation therapy of liver cancer include iodine-131 Lipiodol and Yttrium-90 microspheres.
Unfortunately, neither external beam radiation nor local radiation therapy has shown
significant benefits in terms of survival in patients with liver cancer.

Novel Therapies for Liver Cancer

The high rates of cancer recurrence following surgery for localized, resectable liver cancer,
estimated to range from 80% to 90%, has prompted the search for newer and potentially
more effective systemic treatments. A variety of novel systemic therapies are currently being
investigated for both localized, resectable liver cancer as well as for advanced-stage disease.
Some of these novel systemic therapies currently under investigation include:

Recombinant Interferon Therapy

A study published in 2003 in the Annals of Internal Medicine reported that interferon
therapy improved survival in patients with liver cancer and Hepatitis C infection. A
summary of this article can be viewed at

http://www.annals.org/cgi/content/abstract/138/4/299

Retinoids

Retinoids are drug derivatives of Vitamin A that are used clinically for the treatment of
severe acne and psoriasis. A study published in 1996 in the New England Journal of
Medicine by a group of researchers from Japan reported that treatment with oral polyprenoic
acid (a retinoid) prevented the recurrence of liver cancer in 89 patients who underwent either
surgical resection or percutaneous ethanol injection as the primary treatment for their liver
cancer. The article abstract can be viewed at

http://www.medifocus.com/abstracts.asp?gid=OC031&ID=8628336

Cellular Therapy

• Adoptive Immunotherapy - This is a form of immunotherapy used for the treatment of

certain cancers in which a patient's white blood cells are exposed to specific growth
factors to increase their ability to recognize and destroy cancer cells. Adoptive
immunotherapy for the treatment of liver cancer currently focuses on activating the

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patients own white blood cells with interleukin-2 and anti-CD3 antibodies. A study
published in 2000 in the British journal The Lancet reported that adoptive immunotherapy
was a safe treatment that could lower recurrence of liver cancer after surgery. The abstract of
this article can be viewed at

http://www.medifocus.com/abstracts.asp?gid=OC031&

ID=11022927

• Vaccines - The theory behind this approach is that a vaccine consisting of the patient's white

blood cells that is exposed to and mixed with specific tumor proteins will activate the white
blood cells to recognize and destroy the cancer cells. One approach currently under
investigation is the use of an autologous formalin-fixed tumor vaccine to prevent recurrence
of liver cancer following surgical resection. A study published in 2004 in Clinical Cancer
Research concluded that an autologous formalin-fixed tumor vaccine was both safe and
effective for the prevention of recurrence of liver cancer following surgical resection. The
abstract of this article can be viewed at

http://www.medifocus.com/abstracts.asp?gid=OC031&ID=15014006

Pravastatin

A study published in 2001 in the British Journal of Cancer reported that the statin drug
pravastatin (Pravachol), prolonged the survival of patients with advanced-stage liver cancer. The
abstract of this article can be viewed at

http://www.medifocus.com/abstracts.asp?gid=OC031&

ID=11286466

Chemotherapy

As mentioned previously, most of the commonly used anticancer drugs, either alone or in
combination, have been shown to have a minimal impact in terms of prolonging survival in
patients with advanced-stage liver cancer. Research is ongoing to investigate the use of other
chemotherapeutic drugs that may prove to be more effective for slowing the rate of progression of
liver cancer. Some of the drugs being investigated include:

• Oral fluoropyrimidines - Combination chemotherapy with tegafur and uracil is being

investigated. A study published in 2001 in the Journal of Gastroenterology and Hepatology
reported improved survival of patients with advanced-stage liver cancer following oral
administration of tegafur/uracil. The article abstract can be viewed at:

http://www.medifocus.com/abstracts.asp?gid=OC031&ID=11354285

• Gemcitabine - This drug is being investigated in combination with other chemotherapeutic

agents (e.g., doxorubicin, oxaliplatin) for the treatment of advanced-stage liver cancer.

• Exatecan mesylate (DX-8951f) - This drug is a new topoisomerase-1 agent that is being

investigated for the treatment of a variety of cancers including ovarian, breast, colon, and
lung cancer and may also have potential as a systemic treatment for patients with
advanced-stage liver cancer.

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Fibrolamellar Hepatocellular Carcinoma

There are several different subtypes of hepatocellular carcinoma that can be differentiated by
examining the liver cancer cells under a microscope. The most important subtype or variant is
known as fibrolamellar hepatocellular carcinoma . This form is a distinct clinical variant of
hepatocellular carcinoma that usually occurs in young patients between ages 20 to 40. The
fibrolamellar variant of hepatocellular carcinoma differs from the "classical" form of
hepatocellular carcinoma in several important aspects including:

• Most patients with fibrolamellar hepatocellular carcinoma do not have underlying cirrhosis

of the liver.

• Hepatitis B infection is very uncommon in patients with fibrolamellar hepatocellular

carcinoma.

• The serum levels of alpha-fetoprotein are usually not elevated in patients with fibrolamellar

hepatocellular carcinoma.

There have been conflicting studies published in the medical literature regarding the issue of
whether patients with fibrolamellar hepatocellular carcinoma have a better prognosis for survival
than patients with the classic form of hepatocellular carcinoma. Whereas some studies have
reported longer survival rates for patients with fibrolamellar hepatocellular carcinoma, other
studies have reported no survival advantage. In general, the prognosis for patients with
fibrolamellar hepatocellular carcinoma is influenced by several important variables including:

• Stage of the disease
• Number of liver tumors present
• Whether or not the tumor has spread to the lymph nodes or other parts of the body. In about

30% of patients with fibrolamellar hepatocellular carcinoma, the tumor has already spread to
the lymph nodes or other areas by the time the disease has been diagnosed.

The treatment options for patients with fibrolamellar hepatocellular carcinoma are, in general, the
same as for patients with the classic form hepatocellular carcinoma. Since most patients with
fibrolamellar hepatocellular carcinoma are diagnosed with localized, resectable disease, surgical
resection and liver transplantation are considered to be the primary treatment options. Some
published studies suggest that surgical resection offers a survival advantage as compared to liver
transplantation, however, this is still the subject of controversy in the medical community.

Prognosis for Liver Cancer

The prognosis for patients with liver cancer depends upon a number of important variables
including:

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• Size of the tumor
• Number of tumors present
• Degree of residual liver function
• Type of treatment
• Overall health of the patient

As mentioned previously, only a small percentage of patients with liver cancer are diagnosed
with localized resectable disease where the tumor can be removed surgically. Most patients
are diagnosed at the advanced-stages of liver cancer where surgery is not a viable treatment
option. In general, the 5-year survival rate for patients with localized, resectable liver cancer
is in the range of 30% to 40%. The prospects for long-term survival following surgical
resection are also complicated by the high rate of recurrence of the cancer which occurs in
more than 70% of cases.

The Role of Complementary and Alternative Therapies in

Cancer

Complementary and Alternative Medicine: Definition of
Terms

The National Center for Complementary and Alternative Medicine (NCCAM) defines
complementary and alternative medicine as "a group of diverse medical and health care
systems, practices, and products that are not presently considered to be a part of
conventional medicine". The term complementary medicine refers to the use of CAM
therapies in addition to or in conjunction with conventional mainstream treatments in an
"integrative" approach to treatment. The term alternative medicine, on the other hand,
refers to the use of CAM therapies as a substitute for or in place of conventional mainstream
treatments.

Although the terms "complementary" and "alternative" are often used interchangeably by
many people when referring to CAM therapies, health care professionals usually make a
clear distinction between these two terms. In general, conventional physicians will keep an
open mind and tend to support the use of "complementary" therapies in conjunction with
standard mainstream treatments while they may resist suggestions for using "alternative"
therapies as a substitute for conventional treatments. In fact, many cancer centers in the
United States have incorporated select complementary therapies along with standard cancer
treatments (e.g., chemotherapy, radiation therapy, surgery) in an emerging field of cancer
care known as integrative oncology. It is important for patients and their families to keep in
mind the very important distinction between the terms "complementary" and "alternative"
when discussing the issue of CAM therapies with their health care provider in order to avoid
confusion and misunderstandings and ensure effective patient-doctor communication.

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The definition of CAM adapted by the NCCAM, which basically defines CAM as any
treatment modality, philosophy, or product that falls outside the realm of conventional or
standard medical care is well-suited for most Western countries where conventional, modern
medicine is the prevailing or predominant health system adapted by the people who live in
that culture. For example, conventional or standard treatments for cancer in most modern
Western countries include chemotherapy, radiation therapy, biological therapy, and surgery.
Other treatment modalities such as acupuncture, hypnotherapy, or the use of shark cartilage
would be considered as being outside the realm of conventional medicine and falling under
the general umbrella of CAM. The definition of CAM adapted by the NCCAM, however, is
more problematic in countries or cultures where a particular form of CAM, such as
Traditional Chinese medicine in China or Ayurvedic medicine in India, represent major
health care systems that are recognized, accepted, and utilized by the general population of
those countries or cultures.

Care Versus Cure

In discussing the role of CAM therapies for the management of cancer, it is important to
differentiate between CAM therapies that purport to "cure" cancer as opposed to those
therapies that are used in palliative cancer care to provide relief from cancer-related
symptoms and improve the patient's quality of life. Unlike some conventional cancer
treatments that have been demonstrated to cure patients with certain types of cancers,
currently there is a lack of sufficient scientific evidence to support the conclusion that any
specific type of CAM modality can cure cancer. Patients who fail to draw a distinction
between the "care versus cure" aspects of CAM therapies may delay seeking or may
completely abandon potentially curative mainstream cancer treatments in hope that a
particular CAM therapy may be a "magic bullet" for curing their cancer. On the other hand,
complementary therapies have become an important aspect of palliative cancer care by
helping cancer patients better cope with cancer-related symptoms and side-effects and,
thereby, improving quality of life. In fact, many cancer centers in the United States and other
Western countries have integrated complementary therapies into their mainstream treatment
strategies for palliative cancer care in an emerging field of cancer practice known as
integrative oncology.

Complementary Therapies for Cancer-Related Symptoms

Conventional cancer treatments such as chemotherapy, radiation therapy, and surgery are
often associated with severe side-effects that can significantly impact the patient's quality of
life and interfere with routine activities of daily living. In general, side-effects of
conventional cancer treatments may include nausea/vomiting, fatigue, anxiety, depression,
pain, sleep disturbances, loss of appetite, dry mouth, gastrointestinal disturbances, and
peripheral neuropathy. Conventional treatments may not always be completely effective in

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relieving cancer-related symptoms and, in some cases, the treatments themselves may cause
additional side-effects. Complementary therapies, when used in conjunction with
conventional mainstream treatments can help patients better cope with cancer-related
symptoms and side-effects and also improve physical and emotional well-being and overall
quality of life.

Psychological Stress

The diagnosis of cancer is a life-altering event that may evoke feelings of anxiety, fear,
depression, hopelessness, and severe psychological stress in many patients. Studies have
shown that about 25% of cancer patients suffer from depression. Conventional treatments
for anxiety, stress, and depression may involve the administration of anti-anxiety
medications or antidepressants which may cause undesirable side-effects in some patients.
Studies have shown that a variety of CAM therapies are useful for controlling anxiety and
other mood disturbances when used in conjunction with conventional treatments. These
include:

• Mind-body interventions - relaxation techniques, guided-imagery, meditation, hypnosis
• Acupuncture
• Massage therapy
• Music therapy

In general, patients with severe mood disturbances (e.g., panic attacks; suicide ideation)
require immediate psychological evaluation and treatment to stabilize their acute condition
before CAM therapies may be considered. For most patients with mild to moderate anxiety
and mood disturbances, CAM therapies are a useful adjunct to conventional treatments for
managing psychological distress. Techniques such as mind-body interventions, acupuncture,
and music therapy are generally safe when performed by qualified, experienced practitioners
and can help cancer patients better cope with feelings of anxiety, fear, hopelessness, and
depression. Although some herbs and dietary supplements (e.g., Kava Kava; St. John's Wort;
Passionflower) have been reported to relieve anxiety and mood disturbances, some experts
have discouraged the use of these products in cancer patients because they may interfere
with drugs used to treat cancer (chemotherapeutic agents) and/or other medications that
patients may be taking. Patients should discuss the risks and benefits of using any herbal
medications/dietary supplements with their oncologist before taking any of these products,
particularly if they are undergoing chemotherapy, radiation therapy, or surgery.

Cancer-Related Pain

Pain is a common symptom that can affect many cancer patients. Most often, the source of
the pain is the tumor itself. Cancer-related pain may be caused by spread of the tumor to
other tissues and organs or may result from compression of the tumor on a nerve or the
spinal cord. In general, acute cancer-related pain is most responsive to conventional
mainstream treatments which may involve medications (e.g., narcotic analgesics; steroids)
or, in severe cases, (e.g., tumor causing spinal cord compression; tumor associated with

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abdominal obstruction), emergent surgery may be required to relieve the acute pain.

As a general rule, CAM therapies are usually not considered as a viable treatment option for
the management of acute cancer-related pain. Once the acute pain has been brought under
control by conventional treatment modalities, CAM therapies may be considered in the
management of chronic cancer-related pain. A potential benefit of using CAM therapies in
conjunction with conventional treatments for the management of chronic cancer-related pain
is that they may reduce the dosage of conventional pain medications that may be required to
achieve chronic pain control and, therefore, also potentially reduce the side-effects that may
be associated with conventional pain medications.

A variety of CAM therapies, when used in conjunction with conventional treatments, may
be beneficial for the management of cancer-related pain, including:

• Meditation
• Guided imagery
• Hypnosis
• Relaxation techniques
• Massage therapy
• Reflexology
• Acupuncture
• Yoga
• Aromatherapy

Some procedures that may be used for the diagnosis and treatment of some types of cancers
may also be associated with pain. Examples include:

• Biopsy - a piece of tissue is removed from the tumor and is examined under a

microscope to determine if it is malignant or benign.

• Placement of a central line catheter that is used to administer chemotherapeutic agents

and/or other medications

• Bone marrow aspiration
• Lumbar puncture

A variety of CAM therapies, particularly mind-body techniques, have been found to be
beneficial for controlling pain associated with cancer-related procedures (both diagnostic
and therapeutic), especially in children with cancer, although they appear to be useful in
adults as well.

Some cancer patients who undergo surgery to remove a tumor develop persistent
neuropathic pain due to injury of nerves during the surgical procedure. In general, severe
neuropathic pain may be difficult to control with conventional pain management treatment
modalities. There is some evidence that acupuncture, when used in conjunction with

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conventional pain management strategies, may be effective for the management of persistent
neuropathic pain that may develop in some patients after cancer surgery.

Nausea and Vomiting

Nausea and vomiting are relatively common side-effects in patients undergoing cancer
chemotherapy. When used in conjunction with standard treatments, CAM therapies may
offer patients additional relief from chemotherapy-induced nausea and vomiting. A 1998
National Institutes of Health (NIH) Consensus Conference concluded that there is clear
evidence supporting the efficacy of acupuncture for controlling nausea and vomiting
associated with cancer chemotherapy. Other CAM therapies that may help cancer patients
better cope with chemotherapy-induced nausea and vomiting include:

• Acupressure
• Aromatherapy
• Hypnosis
• Guided imagery
• Music therapy
• Massage therapy

Other Cancer-Related Symptoms

There is a limited amount of evidence which suggests that CAM therapies may be useful for
helping patients to better cope with a variety of other common cancer-related symptoms
including:

• Fatigue - A study published in 2004 in the Journal of Clinical Oncology (Vol. 22, Issue

9; pp. 1731-1735) reported that acupuncture reduced chemotherapy-related fatigue by
31% after 6 weeks of acupuncture treatment.

• Dry Mouth (xerostomia) - Several studies suggest that acupuncture may be useful in the

management of dry mouth that occurs in some patients undergoing radiation therapy to
the head and neck.

• Hot Flashes - Some women with breast cancer who are treated with a drug called

tamoxifen may experience hot flashes that can be very uncomfortable. A study
published in 2002 in the journal Tumori (Volume 88, Issue 2; pp. 128-130) reported
that acupuncture may relieve menopause-related symptoms, including hot flashes, in
women taking tamoxifen.

• Lymphedema - A study published in 2002 in the European Journal of Cancer Care

(Volume 11; Issue 4, pp. 254-261) reported that a specific type of massage therapy
known as manual lymphatic drainage (MLD) was beneficial for the treatment of breast
cancer related lymphedema and also improved overall quality of life.

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• Insomnia - A variety of mind-body therapies (e.g., relaxation techniques; meditation;

biofeedback) may help to improve the quality of sleep of cancer patients who
experience insomnia.

Dietary Modification and Supplementation

Evidence from epidemiological studies strongly supports a relationship between dietary
factors and the risk for developing certain types of cancers. In general, a diet that is rich in
certain food constituents (e.g., fruits, vegetable, fiber) appears to be protective against the
development of cancer. In contrast, excessive consumption of other dietary substances (e.g.,
animal fats, alcohol) appears to increase the risk of certain types of cancers. Some vitamins
that possess antioxidant properties (e.g., vitamins A, C, and E) may protect against certain
types of cancers by protecting the body's cells from damage by certain compounds known as
free radicals.

The role of dietary modification and antioxidant vitamin supplementation in slowing the
progression of cancer continues to be an area of ongoing research. Currently, there are no
conclusive studies which prove that any type of dietary modification or antioxidant vitamin
supplementation can alter the progression of the disease in cancer patients.

Cancer patients who are considering dietary modification and/or antioxidant vitamin
supplementation need to be aware of certain risks that may be associated with these
regimens:

• Unintentional weight loss is a relatively common side-effect of cancer treatment,

particularly among patients who are undergoing chemotherapy and/or radiation
therapy. Excessive reduction of certain dietary components, such as dietary fat intake,
may increase the risk of malnutrition in cancer patients. It is, therefore, important for
patients to discuss the potential risks and benefits of any dietary modification with their
oncologist before making a decision to modify their dietary intake.

• Some radical dietary regimens, such as macrobiotic diets (that are primarily vegetarian)

may potentially promote the progression of disease in women with estrogen-receptor
positive breast cancer or endometrial cancer due to their high content of isoflavonoid
phytoestrogens. The same concern applies to diets that promote soy supplementation as
a means of slowing the progression of cancer. Soy products contain high amounts of
isoflavonoid phytoestrogens and should be avoided by women with estrogen-receptor
positive tumors.

• High doses of certain antioxidant vitamin supplements (vitamins C and E) may increase

the risk of bleeding complications in patients who have low levels of platelets in the

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bloodstream (thrombocytopenia) or patients who are taking anticoagulant medications.
High doses of vitamin A can cause a condition called Hypervitaminosis A (Vitamin A
toxicity) that can cause symptoms such as nausea, vomiting, headaches, blurry vision, and
impaired consciousness.

Herbal Products

Currently there is a lack of sufficient scientific evidence to recommend the use of herbal products
or supplements for the treatment of cancer. The safety of herbal formulations and products is also
a major factor that should be taken into consideration by consumers. The National Center for
Complementary and Alternative Medicine (NCCAM) urges consumers to be aware of several
important safety issues pertaining to herbal products and supplements, including:

• Do not necessarily assume that just because many of these products are labeled as "natural",

they are completely safe and, therefore, cannot cause potentially serious adverse reactions. If
you have any concerns about the possible side-effects of a particular herbal product or
supplement, ask a pharmacist or your doctor about possible side-effects or interactions with
other medications that you may be taking.

• Women who are pregnant or who are nursing should be especially cautious about using

herbal products and supplements since the safety of many of these products has not
established for use during pregnancy or lactation.

• Find out as much information as you can about a particular herbal product you are

considering before taking it. If you have concerns or questions about a product, speak to a
health care professional and get their advice. Moreover, you should always only use these
products under the guidance of a health care professional.

• Some herbal products and supplements may interact with other medications that you may be

taking and may cause adverse side-effects. Some herbal products may interfere with the
action of certain chemotherapeutic agents that are used in the treatment of cancer. It is,
therefore, important to notify your doctor about any herbal products you may be using or are
considering using in order to prevent or reduce the possibility of adverse herb/drug
interactions.

Quality of Life Issues in Cancer

The diagnosis of any type of cancer is a frightening, life-altering event for both the patient and
their family. The potential for a diminished quality of life for newly diagnosed cancer patients
becomes an immediate, pressing concern when confronted with anxiety, fear, pain, the prospect

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of a long course of treatments that may cause significant side effects, and the possibility that the
treatments may not work. It is critically important, however, for cancer patients and their families
to address and learn to cope with the physical, emotional, and social issues that, if ignored and
left to "fester", can rapidly lead to a significantly reduced quality of life.

Over the years, cancer specialists and other allied health-care professionals have come to
realize that addressing a cancer patient's quality of life issues is an integral component of a
comprehensive, overall cancer treatment strategy. From a practical perspective, that means
developing an effective treatment plan that aims not only to control and/or to eradicate the
patient's cancer with medical and/or surgical therapy but, at the same time, also takes into
consideration critical issues of supportive care throughout the course of treatment and offers
the patient the best chances of maintaining a reasonably high level quality of life. In fact,
most cancer specialists now consider supportive care as an essential component of an
overall, effective cancer treatment plan.

Factors Affecting Quality of Life in Cancer Patients

Cancer patients are confronted with a variety of physical, emotional, and social issues that, if
left unchecked or ignored, can rapidly contribute to a diminished quality of life. In general,
some of the more common problems encountered by cancer patients either as a result of the
disease itself or as a side-effect of cancer treatments include:

• Sleep disorders
• Fatigue
• Diminished exercise capacity
• Unintentional weight loss
• Psychological stress
• Cancer-related pain

Sleep Disorders

Lack of adequate sleep due to anxiety, stress, pain, or treatment side-effects can lead to
severe daytime fatigue that, in turn, can interfere with the ability to function and perform
routine activities of daily living. Perhaps now, more than ever before, getting an adequate
amount of sleep is critical to enable the body and mind to cope with the additional physical
and emotional burdens resulting from cancer and its treatment. If sleep disturbances begin to
affect your functional ability and diminish your quality of life, a variety of options are
available to deal with the problem. These treatment options include learning new sleep
habits (improved sleep hygiene practices); complementary therapies (e.g., relaxation
techniques, biofeedback, meditation); and the use of prescription sleep medications. If lack
of sleep is affecting your quality of life and interfering with your activities of daily living,
talk with your doctor about developing an individualized treatment plan to help improve
your quality of sleep.

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Fatigue

Fatigue is perhaps the most common and potentially debilitating symptom experienced by
cancer patients that can have a significant negative impact on routine activities of daily
living and diminish quality of life. Fatigue may be attributed to a variety of causes including
side-effects of cancer treatments (e.g., chemotherapy, radiation therapy), anemia, sleep
deprivation resulting from insomnia, chronic pain, inadequate nutrition, and lack of physical
exercise. In many cases, a combination of factors contributes to fatigue, exhaustion, and a
general lack of energy. It is important to notify your cancer specialist or primary health care
provider if you begin to experience bouts of fatigue lasting a few days or longer.

A variety of strategies are available to overcome the problem of fatigue in cancer patients.
Fatigue related to anemia (low numbers of red blood cells) can be treated with blood
transfusions and drugs, such as erythropoietin (e.g., Procrit) that promote the production of
red blood cells. Fatigue not related to anemia may be managed with lifestyle modifications
such as proper nutrition, regular exercise, and improved sleep hygiene practices.

Exercise

In the past, cancer patients were usually advised to "relax", "take it easy" and "don't overdo
it". More recently, however, doctors are beginning to realize the potential benefits of
physical exercise for cancer patients undergoing treatment as well as for cancer survivors.
Researchers are continuing to explore the effect of physical exercise on survival rates for
various types of cancers. In general, the potential benefits of physical activity for patients
suffering from chronic diseases include enhanced physical and mental function and
improved quality of life. For cancer patients, the potential benefits of exercise also include
decreased fatigue, improved appetite, better toleration of side effects of chemotherapy and
radiation therapy and improved quality of life.

It is important to speak to your cancer specialist about the types of exercises that may be
appropriate at various stages of you cancer treatment and the types of physical activities that
you should avoid.

Unintentional Weight Loss

One of the most common symptoms experienced by cancer patients is unintentional weight
loss which can lead to malnutrition, increased susceptibility to infections, reduced quality of
life, and shorter survival time. The underlying causes of unintentional weight loss in cancer
patients may be attributed to a variety of factors including loss of appetite associated with
chemotherapy and/or radiation therapy and psychological disturbances such as depression
which has been found to affect up to 25% of cancer patients.

From a metabolic perspective, unintentional weight loss may be understood by the increased
energy (calories) required by cancer cells to grow and spread as well as the increased energy
requirements of the body to mount an effective response to fight the cancer. A net loss in

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weight occurs when the body uses more calories from stored energy reserves than is
available from calories ingested from nutrients in the diet. Metabolic changes in cancer can
also cause a condition called cachexia - a generalized wasting condition involving the loss of
muscle mass and fat. Cachexia may develop even in people with good nutritional intake due
to the failure of the body to absorb nutrients. Symptoms of cachexia, which affects about
50% of all cancer patients, include loss of appetite, weight loss, wasting of muscle mass,
generalized fatigue, and significantly reduced capacity to perform routine activities of daily
living.

The management of weight loss in cancer patients usually involves nutritional counseling to
ensure an adequate intake of calories. Nutritional counseling can also help cancer patients
develop new eating habits to prevent further weight loss including eating foods that are rich
in calories or protein; eating smaller meals more frequently throughout the course of the day;
"snacking" between meals; and drinking high-calorie liquid nutritional supplements (e.g.,
Boost, Ensure, Sustacal). In some cases, medications such as megestrol acetate (Megace) or
dexamethasone (Decadron) may be prescribed to stimulate the appetite.

Your cancer specialist, working together with a nutritionist and a dietician, can help you
develop and maintain a well-balanced diet to ensure that your body receives an adequate
level of nutrition not only during the course of your cancer treatments but also during the
recovery phase.

Psychological Stress

The diagnosis of cancer is a life-altering event that may evoke feelings of anxiety, fear,
depression, hopelessness, and severe psychological stress in many patients. Studies have
shown that about 25% of cancer patients suffer from depression. Conventional treatments
for anxiety, stress, and depression may involve the administration of prescription
anti-anxiety medications or antidepressants which may cause undesirable side-effects in
some patients. Specific types of psychotherapy or "talk therapy" can also help relieve
depression in cancer patients.

Studies have shown that a variety of complementary and alternative medicine (CAM)
therapies are useful for controlling anxiety and other mood disturbances when used in
conjunction with conventional treatments. These include:

• Mind-body interventions - relaxation techniques, guided-imagery, meditation, hypnosis
• Acupuncture
• Massage therapy
• Music therapy

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and mood disturbances, CAM therapies are a useful adjunct to conventional treatments for
managing psychological distress. Techniques such as mind-body interventions, acupuncture,
and music therapy are generally safe when performed by qualified, experienced practitioners
and can help cancer patients better cope with feelings of anxiety, fear, hopelessness, and
depression. Although some herbs and dietary supplements (e.g., Kava Kava; St. John's Wort;
Passionflower) have been reported to relieve anxiety and mood disturbances, some experts
have discouraged the use of these products in cancer patients because they may interfere
with drugs used to treat cancer (chemotherapeutic agents) and/or other medications that
patients may be taking. Patients should discuss the risks and benefits of using any herbal
medications/dietary supplements with their oncologist before taking any of these products,
particularly if they are undergoing chemotherapy, radiation therapy, or surgery.

Cancer-Related Pain

Pain is a relatively common symptom that is experienced by many cancer patients. In recent
years, increased awareness about this problem has led to important advances in the
management of patients with cancer-related pain. In fact, today most major cancer centers in
the United States have established pain management clinics, usually located within the
Anesthesiology department of a hospital, that specialize in helping patients to better control
their cancer-related pain.

Most often, the source of cancer-related pain is the tumor itself. This can occur when a
tumor spreads and invades other tissues or organs of the body; when a tumor compresses a
nearby nerve or the spinal cord; or when a tumor causes intestinal obstruction.
Cancer-related pain may also be caused by some procedures that are used for the diagnosis
and treatment of cancer. Examples include tissue biopsy; placement of a central line
catheter; bone marrow aspiration; and spinal tap.

Irrespective of the source of your cancer pain, it is important to notify your oncologist or
primary care doctor about any pain or discomfort that you may be experiencing so that
appropriate measures can be taken to eliminate or better control the pain. In developing an
individualized pain control strategy, your doctor will want to learn as much as possible
about the pain you are experiencing, including:

• When did the pain start?
• How long does the pain last (acute or chronic)?
• Is the pain minor, moderate, or severe?
• Is the pain localized to a particular area of the body?
• Are there any specific activities or events that either "trigger" the pain or help to

alleviate the pain?

• To what extent does the pain interfere with your quality of life and activities of daily

living?

• Are you currently taking any pain medications?

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Drug Therapy for Cancer-Related Pain

A wide range of pain medications is available for helping patients better cope with
cancer-related pain. Your doctor will determine the specific type of medication that is most
suitable for you based on the information you provide including the severity of the pain
(e.g., mild, moderate, or severe) and the duration of the pain. You can help your doctor in
selecting the most appropriate pain medication for your specific type of cancer pain by
providing him/her with as much information as possible about the nature and characteristics
of the pain. Be sure to also notify your doctor if:

• You are allergic to any medications
• You have previously experienced any serious side-effects from pain medications (e.g.,

gastrointestinal bleeding)

• You have a current or past history of stomach ulcers
• You are taking any other pain medications including herbal products or medications.

In general, the following pain medication treatment options are available in the management
of cancer-related pain based upon the severity of the pain:

• Non-Steroidal Anti-Inflammatory Drugs - Mild cancer-related pain can usually be

managed with a variety of pain medications that belong to the general family of drugs
known as non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs that
are available "over-the-counter" include:

• aspirin (e.g., Bayer)
• acetaminophen (e.g., Tylenol)
• ibuprofen (e.g., Motrin)
• naproxen (e.g., Aleve)

Some NSAIDs used for the treatment of pain, including cancer-related pain, are available by
prescription only. Examples include diclofenac (e.g., Voltaren); indomethacin (Indocin);
ketoprofen (e.g., Orudis); and Cox-2 inhibitors (e.g., Celebrex), among others.

• Narcotic (Opioid) Analgesics - If you are experiencing mild to moderate cancer-related

pain, your doctor may prescribe a medication that belongs to a family of drugs known
as narcotic analgesics. Examples include:

• codeine
• morphine
• buprenorphine (e.g., Subutex; Suboxone)
• fentanyl (e.g., Duragesic)
• oxycodone (e.g., OxyNorm; OxyContin)
• hydrocodone (e.g., Vicodin; Lortab)

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• hydromorphone (e.g., Dilaudid)

In some cases, combination pain medication tablets containing an NSAID plus a narcotic
analgesic may be prescribed for the management of mild to moderate cancer-related pain.
Examples of combination pain medication tablets include Percodan (aspirin plus oxycodone);
Percocet (acetaminophen plus oxycodone); Co-codamol (acetaminophen plus codeine); and
Co-codaprin (aspirin plus codeine)

As a general "rule of thumb", cancer patients with mild to moderate pain are usually started on
"weaker" opioid-based medications (e.g., codeine) and, if necessary, are switched to stronger
opioid medications (e.g., fentanyl, oxycodone, morphine).

Common side-effects of narcotic analgesics include constipation, lethargy, drowsiness,
nausea/vomiting, and sleepiness. In addition, a major concern with the use of narcotic analgesics
is the possibility of addiction to the medications. Be sure you notify your doctor if you have a
current or past history of drug and/or alcohol abuse before taking narcotic analgesics. Also speak
with your doctor about strategies that can be used to manage the side-effects of narcotic
analgesics. For example, constipation may be managed by taking a stool softener (e.g., Colace;
Senokot). If you experience drowsiness or sleepiness when you take your pain medication, you
should avoid any activities that may pose a danger to yourself or others (e.g., driving a car;
mowing the lawn).

• Adjuvant Pain Medications - Some drugs that are primary used to treat conditions other than

pain also possess analgesic (pain-relieving) properties. These drugs are known as adjuvant
pain medications and are sometimes prescribed, alone or in combination with other
medications, for the management of cancer-related pain. Examples include:

• anticonvulsants - This class of drugs is used primarily to treat seizures. Examples of

anticonvulsants that may also be used to treat cancer pain include: gabapentin
(e.g.,Neurontin); carbamazepine (e.g., Tegretol); phenytoin (e.g., Dilantin); and
topiramate (e.g., Topamax)

• antidepressants - This class of drugs is used primarily to treat depression. Examples of

antidepressants that may be also be used to treat cancer pain include: amitriptylene
(e.g., Elavil); desipramine (e.g., Norpramin); doxepin (e.g., Sinequon); and
impipramine (e.g., Tofranil).

• bisphosphonates - This class of drugs is used primarily for the treatment of

osteoporosis. Studies have also demonstrated that bisphosphonates may relieve bone
pain in cancer patients. Examples include: alendronate (e.g., Fosamax); pamidronate
(Aredia); and etidronate (e.g., Didronel).

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• corticosteroids - This class of drugs is used primarily to treat inflammatory conditions

such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. By reducing
inflammation, corticosteroids also reduce pain. A common type of corticosteroid drug
used for the management of cancer pain is dexamethasone (e.g., Dexmethsone).

• Breakthrough Cancer Pain - Despite the regular use of pain medications on a fixed schedule,

many cancer patients (estimates range from 50% to 65%) experience a type of pain known
as breakthrough cancer pain. This type of pain is characterized by a sudden onset, may last
from minutes to hours, and is usually severe in nature. Breakthrough cancer pain occurs
most often in patients who are experiencing persistent or chronic cancer pain who notice a
sudden, periodic "flare-up" of severe pain even though they are taking pain medication on a
regular schedule.

Breakthrough cancer pain is most often treated with opioid medications that act quickly, such as
immediate release morphine tablets or capsules, but are rapidly eliminated from the body so that
they cause less side-effects. The U.S. Food and Drug Administration (FDA) has also approved a
drug called ACTIQ (Oral Transmucosal Fentanyl Citrate) in the form of a lozenge on a stick that
dissolves slowly in the mouth for the treatment of breakthrough cancer pain. Be sure to notify
your doctor if you think you may be experiencing breakthrough pain that is not controlled with
your regular fixed-schedule pain medications so that he/she may determine the best course of
treatment to alleviate your pain.

For more information about cancer-related pain and the treatment options, please click on the
following link:

http://www.cancer-pain.org

The Role of Complementary and Alternative Medicine Therapies in Cancer-Related Pain

As a general rule, complementary and alternative medicine (CAM) therapies are usually not
considered as a viable treatment option for the management of acute cancer-related pain. Acute
cancer-related pain usually responds best to conventional drug therapy (e.g., NSAIDs; narcotic
analgesics; adjuvant pain medications). Surgery may also be necessary for the treatment of some
types of acute cancer pain such as when a tumor compresses a nearby nerve or the spinal cord or
if the tumor is causing abdominal or intestinal obstruction. Once the acute pain has been brought
under control by conventional treatment modalities, CAM therapies may be considered in the
management of chronic (persistent) cancer-related pain. A potential benefit of using CAM
therapies in conjunction with conventional treatments for the management of chronic
cancer-related pain is that they may reduce the dosage of conventional pain medications that may
be required to achieve chronic pain control and, therefore, also potentially reduce the side-effects
that may be associated with conventional pain medications.

A variety of CAM therapies, when used in conjunction with conventional treatments, may be
beneficial for the management of chronic cancer-related pain, including:

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• Meditation
• Guided imagery
• Hypnosis
• Relaxation techniques
• Massage therapy
• Reflexology
• Acupuncture
• Yoga
• Aromatherapy

Where Can You Find Supportive Care?

Fortunately, supportive care is available for cancer patients and their families from a
multitude of resources. These include:

• Cancer Centers - The hospital or cancer center where you have chosen to receive your

treatment is an excellent starting point in your search for supportive cancer care. Many
major hospitals and comprehensive cancer centers provide access to a variety of
resources for cancer patients including educational, psychological, and social services
support.

• Your Cancer Physician - The primary cancer specialist who is in charge of your care

and is responsible for your overall treatment is also an excellent resource of
information and support. These cancer specialists are in the business of caring for
cancer patients and usually have a wealth of knowledge about the physical,
psychological, and social issues confronting patients who have been diagnosed with
cancer. Depending upon your specific type of cancer, a variety of cancer specialists
may be involved in your treatment including an:

• oncologist
• hematologist
• radiation oncologist
• surgical oncologist

• Oncology Nurses - If your treatment plan includes chemotherapy, you will be assigned

a nurse oncologist who will administer your drugs and monitor side-effects or other
problems that may occur during your chemotherapy sessions. Nurse oncologists are
highly trained professionals who are a wonderful source of information and can provide
educational materials, emotional support, and practical tips for dealing with adverse
side-effects of chemotherapy such as nausea, fatigue, and pain.

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• Your Primary Care Physician - It is likely that a visit to your primary care physician led

to the discovery and diagnosis of your cancer and that your primary care physician
referred you to a cancer specialist for treatment. Your primary care physician will
usually work closely with your cancer specialist in following your progress both during
as well as after treatment has been completed. It is important to be open and frank with
your primary care physician and talk to him/her about any physical or emotional
problems that you may experience so that they can help you get over these difficult
periods.

• Nurse Practitioners - Nurse practitioners are registered nurses (RNs) who have

completed additional courses and training. They can work with or without the
supervision of a physician. Their scope of work includes both diagnosis and treatment
of diseases and, in many states, they can also write prescriptions.

• Physician's Assistants - A physician's assistant is a licensed health care professional

who provides care under the supervision of a physician. Physician's assistants provide a
broad range of diagnostic and therapeutic services including ordering and interpreting
laboratory tests, diagnosing and treating diseases and conditions, conducting physical
examinations, and assisting in surgery.

• Nutritionists/Dieticians - Consultation with a nutritional expert can help ensure that you

maintain an adequate level of nutrition throughout your cancer treatment and that your
body has sufficient energy to withstand the rigorous cancer treatments which may carry
significant side-effects. Well-nourished cancer patients also have more energy and are
less prone to experience severe fatigue and exhaustion.

• Social Workers - A social worker who is experienced in working with cancer patients

(oncology social workers) can provide valuable assistance in dealing with a variety of
social and emotional issues including:

• teaching patients and families to navigate the complexities of the health-care

system

• helping with financial and health insurance issues
• assisting family members in adjusting to new roles and responsibilities
• arranging home health care for patients requiring home-based treatments
• providing access to local, state, and government agencies that provide social and

health services

• helping cancer patients deal with employees and return to work issues

• Mental Health Professionals - A psychiatrist or psychologist with expertise in

diagnosing and treating psychological and emotional disturbances in cancer patients
(e.g., anxiety, fear, depression, self-image issues) is an integral member of the
comprehensive cancer team who can help patients better cope and adjust to living with

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cancer.

• Clergy - A trusted member of the clergy can provide spiritual guidance, reassurance, and

hope to cancer patients and their families.

• Sex Therapists - A sex therapist can help cancer patients who experience a reduced libido or

other sexual problems that may develop as a consequence of the cancer itself or treatment
related side-effects.

• Family and Friends - Family, friends, and long-term acquaintances who know you best are

one of your most important support networks and can provide emotional support, guidance,
and encouragement both during and long after you completed your course of cancer therapy.
Now, more than ever, you need to open-up to your family and friends and share your
feelings, fears, and emotions with them. They will appreciate your willingness to trust and
confide in them and you will benefit from their reassurance, encouragement, positive
attitude, and continuous love.

• Organizations and Support Groups - A broad range of organizations and support groups that

specialize in helping cancer patients and their families represent a valuable source of
support, networking, access to services, and for obtaining important educational cancer
materials. Some of these major organizations may be located in your city and some cancer
support groups may even have branches in your neighborhood. Joining a cancer support
group may be one of the most important steps you take to help yourself on the road to
recovery. Networking and with other cancer patients and cancer survivors who understand
and share your fears and concerns can be an important source of consolation, comfort, and
peace of mind knowing that you are not alone in this battle. Other cancer patients have been
down this road before and learning about their personal experiences and coping strategies
can help you work your way through this difficult period in your life.

Questions to Ask Your Doctor about Liver Cancer

• What is the stage of my liver cancer?
• What are my treatment options?
• Which treatments do you recommend and why?
• Is the treatment intended to be curative or palliative?
• Am I a candidate for a liver transplantation?
• What side effects should I expect from the treatment?
• What ongoing monitoring is needed to determine the progression of the disease?
• What kind of support care do you offer for liver cancer patients?
• What is the prognosis for my stage of liver cancer?
• Are there any clinical trials for which I may be eligible to participate?

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3 - Guide to the Medical Literature

Introduction

This section of your MediFocus Guidebook is a comprehensive bibliography of important recent medical
literature published about the condition from authoritative, trustworthy medical journals. This is the same
information that is used by physicians and researchers to keep up with the latest advances in clinical
medicine and biomedical research. A broad spectrum of articles is included in each MediFocus Guidebook
to provide information about standard treatments, treatment options, new developments, and advances in
research.

To facilitate your review and analysis of this information, the articles in this MediFocus Guidebook are
grouped in the following categories:

• Review Articles - 20 Articles
• General Interest Articles - 23 Articles
• Drug Therapy - 6 Articles
• Surgical Therapy - 18 Articles
• Clinical Trials - 32 Articles
• Radiation Therapy - 4 Articles
• Liver Transplantation - 4 Articles
• Radiofrequency Ablation - 6 Articles
• Arterial Embolization - 8 Articles

The following information is provided for each of the articles referenced in this section of your MediFocus
Guidebook:

• Title of the article
• Name of the authors
• Institution where the study was done
• Journal reference (Volume, page numbers, year of publication)
• Link to Abstract (brief summary of the actual article)

Linking to Abstracts: Most of the medical journal articles referenced in this section of your MediFocus
Guidebook include an abstract (brief summary of the actual article) that can be accessed online via the
National Library of Medicine's PubMed® database. You can easily access the individual abstracts online
via PubMed® from the "electronic" format of your MediFocus Guidebook by clicking on the URI that is
provided for each cited article. If you purchased a printed copy of the MediFocus Guidebook, you can still
access the abstracts online by entering the individual URI for a particular abstract into your computer's web
browser.

www.medifocus.com

(800) 965-3002

Recent Literature: What Your Doctor Reads

Database: PubMed <June 2005 to June 2007>

Review Articles

Hepatocellular cancer: a guide for the internist.

Authors:

Parikh S; Hyman D

Institution:

Department of Medicine, Baylor College of Medicine, Houston, Tex, USA.
parikh@bcm.tmc.edu

Journal:

Am J Med. 2007 Mar;120(3):194-202.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17349437

Liver-directed therapies for patients with primary liver cancer and hepatic metastases.

Authors:

Arciero CA; Sigurdson ER

Institution:

Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue,
Philadelphia, PA 19111, USA.

Journal:

Curr Treat Options Oncol. 2006 Sep;7(5):399-409.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16904057

Liver-directed therapies for hepatocellular carcinoma.

Authors:

Arciero CA; Sigurdson ER

Institution:

Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia,
Pennsylvania 19111, USA.

Journal:

J Natl Compr Canc Netw. 2006 Sep;4(8):768-74.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16948955

New therapies for hepatocellular carcinoma.

Authors:

Avila MA; Berasain C; Sangro B; Prieto J

Institution:

Division of Hepatology and Gene Therapy, Center for Applied Medical Research
(CIMA), University of Navarra, Pamplona, Spain.

Journal:

Oncogene. 2006 Jun 26;25(27):3866-84.

www.medifocus.com

(800) 965-3002

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16799628

Liver transplantation for hepatocellular carcinoma: an update.

Authors:

Botha JF; Langnas AN

Institution:

Department of Surgery, Section of Transplantation, UNMC Eppley Cancer Center at
The Nebraska Medical Center, Omaha, NE 68198-3285. jbotha@unmc.edu

Journal:

J Natl Compr Canc Netw. 2006 Sep;4(8):762-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16948954

New aspects of diagnosis and therapy of hepatocellular carcinoma.

Authors:

Bruix J; Hessheimer AJ; Forner A; Boix L; Vilana R; Llovet JM

Institution:

BCLC Group, Liver Unit, IDIBAPS, Digestive Disease Institute, Hospital Clinic,
University of Barcelona, Catalonia, Spain. bruix@ub.edu

Journal:

Oncogene. 2006 Jun 26;25(27):3848-56.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16799626

Gene therapy of liver cancer.

Authors:

Hernandez-Alcoceba R; Sangro B; Prieto J

Institution:

Division of Gene Therapy and Hepatology, Edificio CIMA, Av. Pio XII, 55, Pamplona
31008, Spain.

Journal:

World J Gastroenterol. 2006 Oct 14;12(38):6085-97.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17036377

Transarterial chemoembolization for hepatocellular carcinoma.

Authors:

Lau WY; Yu SC; Lai EC; Leung TW

Institution:

Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong
Kong, HKSAR, China.

Journal:

J Am Coll Surg. 2006 Jan;202(1):155-68. Epub 2005 Oct 19.

Abstract Link:

ABSTRACT NOT AVAILABLE

www.medifocus.com

(800) 965-3002

Hepatocellular carcinoma.

Author:

Marrero JA

Institution:

University of Michigan, Ann Arbor, 48109, USA. jmarrero@umich.edu

Journal:

Curr Opin Gastroenterol. 2006 May;22(3):248-53.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16550039

10.

Multidisciplinary treatment of patients with hepatocellular carcinoma.

Authors:

Masaki T; Morishita A; Kurokohchi K; Kuriyama S

Institution:

Kagawa Medical University, Third Department of Internal Medicine, 1750-1 Ikenobe
Miki-cho, Kita-gun, Kagawa 761-0793, Japan. tmasaki@kms.ac.jp

Journal:

Expert Rev Anticancer Ther. 2006 Oct;6(10):1377-84.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17069523

11.

Hepatocellular carcinoma. An overview.

Authors:

Motola-Kuba D; Zamora-Valdes D; Uribe M; Mendez-Sanchez N

Institution:

Department of Biomedical Research and Liver Unit, Medica Sur Clinic & Foundation,
Mexico City, Mexico.

Journal:

Ann Hepatol. 2006 Jan-Mar;5(1):16-24.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16531960

12.

Angiogenesis and antiangiogenic therapy in hepatocellular carcinoma.

Authors:

Pang R; Poon RT

Institution:

Department of Medicine, Centre for Cancer Research, The University of Hong Kong,
Pokfulam, Hong Kong, China.

Journal:

Cancer Lett. 2006 Oct 28;242(2):151-67. Epub 2006 Mar 27.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16564617

www.medifocus.com

(800) 965-3002

13.

Emerging drugs for hepatocellular carcinoma.

Authors:

Roberts LR; Gores GJ

Institution:

Mayo Clinic College of Medicine, Miles and Shirley Fiterman Center for Digestive
Diseases, 200 First Street SW, Rochester, MN 55905, USA. Roberts.Lewis@mayo.edu

Journal:

Expert Opin Emerg Drugs. 2006 Sep;11(3):469-87.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16939386

14.

Selection of patients with hepatocellular carcinoma for liver transplantation.

Authors:

Sutcliffe R; Maguire D; Portmann B; Rela M; Heaton N

Institution:

Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS,
UK.

Journal:

Br J Surg. 2006 Jan;93(1):11-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16329080

15.

Radiofrequency ablation of liver tumors: a systematic review.

Authors:

Sutherland LM; Williams JA; Padbury RT; Gotley DC; Stokes B; Maddern GJ

Institution:

Australian Safety and Efficacy Register of New Interventional Procedures-Surgical,
Royal Australasian College of Surgeons, Stepney.

Journal:

Arch Surg. 2006 Feb;141(2):181-90.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16490897

16.

Early detection and curative treatment of early-stage hepatocellular carcinoma.

Author:

Kudo M

Institution:

Department of Gastroenterology and Hepatology, Kinki University School of Medicine,
Osaka, Japan. m-kudo@med.kindai.ac.jp

Journal:

Clin Gastroenterol Hepatol. 2005 Oct;3(10 Suppl 2):S144-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16234064

www.medifocus.com

(800) 965-3002

17.

Radiofrequency ablation for malignant liver tumor.

Authors:

Ng, Kelvin K; Poon, Ronnie T

Institution:

Department of Surgery, Centre for the Study of Liver Disease, The University of Hong
Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.

Journal:

Surg Oncol 2005 Jul;14(1):41-52.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P15777889

18.

How should patients with hepatocellular carcinoma recurrence after liver
transplantation be treated?

Authors:

Schwartz M; Roayaie S; Llovet J

Institution:

Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York,
USA. myron.schwartz@mssm.edu

Journal:

J Hepatol. 2005 Oct;43(4):584-9.

Abstract Link:

ABSTRACT NOT AVAILABLE

19.

Transarterial chemoembolization in a patient with recurrent hepatocellular carcinoma
and portal vein thrombosis: a case report and review of the literature.

Authors:

Sikander A; Sadashiv S; Ronald S; Milind J

Institution:

Department of Medicine, Roswell Park Cancer Institute and State University of New
York at Buffalo, NY 14263, USA. ailawadhi77@yahoo.com

Journal:

Am J Clin Oncol. 2005 Dec;28(6):638-9.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16317281

20.

Opportunities for targeted therapies in hepatocellular carcinoma.

Authors:

Thomas MB; Abbruzzese JL

Institution:

Department of Gastrointestinal Medical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, 77030, USA. methomas@mdanderson.org

Journal:

J Clin Oncol. 2005 Nov 1;23(31):8093-108.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16258107

www.medifocus.com

(800) 965-3002

General Interest Articles

21.

Outcome of patients with huge hepatocellular carcinoma after primary resection and
treatment of recurrent lesions.

Authors:

Lee SG; Hwang S; Jung JP; Lee YJ; Kim KH; Ahn CS

Institution:

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery,
Asan Medical Centre, University of Ulsan College of Medicine, Seoul 138-736, Korea.
sglee2@amc.seoul.kr

Journal:

Br J Surg. 2007 Mar;94(3):320-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17205495

22.

Hepatic steatosis is associated with increased frequency of hepatocellular carcinoma in
patients with hepatitis C-related cirrhosis.

Authors:

Pekow JR; Bhan AK; Zheng H; Chung RT

Institution:

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.

Journal:

Cancer. 2007 Jun 15;109(12):2490-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17487861

23.

Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue--initial
experience.

Authors:

Sahani DV; Holalkere NS; Mueller PR; Zhu AX

Institution:

Department of Abdominal Imaging and Interventional Radiology, Massachusetts
General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
dsahani@partners.org

Journal:

Radiology. 2007 Jun;243(3):736-43.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17517931

www.medifocus.com

(800) 965-3002

24.

Epigenetic combination therapy as a tumor-selective treatment approach for
hepatocellular carcinoma.

Authors:

Venturelli S; Armeanu S; Pathil A; Hsieh CJ; Weiss TS; Vonthein R; Wehrmann M;
Gregor M; Lauer UM; Bitzer M

Institution:

Department of Internal Medicine I, Medical University Clinic, Tubingen, Germany.

Journal:

Cancer. 2007 May 15;109(10):2132-41.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17407132

25.

Hepatocellular carcinoma in young adults: the clinical characteristics, prognosis, and
findings of a patient survival analysis.

Authors:

Yamazaki Y; Kakizaki S; Sohara N; Sato K; Takagi H; Arai H; Abe T; Katakai K;
Kojima A; Matsuzaki Y; Mori M

Institution:

Department of Medicine and Molecular Science, Gunma University Graduate School of
Medicine, 3-39-15 Showa-machi, Maebashi, 371-8511 Gunma, Japan.

Journal:

Dig Dis Sci. 2007 Apr;52(4):1103-7. Epub 2007 Feb 16.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17380407

26.

Combined therapy of transcatheter arterial chemoembolisation and three-dimensional
conformal radiotherapy for hepatocellular carcinoma.

Authors:

Zhou ZH; Liu LM; Chen WW; Men ZQ; Lin JH; Chen Z; Zhang XJ; Jiang GL

Institution:

Department of Integrative Chinese and Western Medicine, Fudan University Cancer
Hospital, Shanghai 200032, China.

Journal:

Br J Radiol. 2007 Mar;80(951):194-201. Epub 2006 Oct 12.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17038412

27.

Comparable survival in patients with unresectable hepatocellular carcinoma treated
by radiofrequency ablation or transarterial chemoembolization.

Authors:

Chok KS; Ng KK; Poon RT; Lam CM; Yuen J; Tso WK; Fan ST

Institution:

Departments of Surgery and Radiology, Centre for the Study of Liver Disease,
University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong
Kong.

Journal:

Arch Surg. 2006 Dec;141(12):1231-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17178966

www.medifocus.com

(800) 965-3002

28.

Treatment and outcomes of treating of hepatocellular carcinoma among Medicare
recipients in the United States: a population-based study.

Authors:

El-Serag HB; Siegel AB; Davila JA; Shaib YH; Cayton-Woody M; McBride R;
McGlynn KA

Institution:

Section of Health Services Research, Houston Veterans Affairs Medical Center, Baylor
College of Medicine, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA.
hasheme@bcm.tmc.edu

Journal:

J Hepatol. 2006 Jan;44(1):158-66. Epub 2005 Nov 2.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16290309

29.

Increased efficacy and safety in the treatment of experimental liver cancer with a novel
adenovirus-alphavirus hybrid vector.

Authors:

Guan M; Rodriguez-Madoz JR; Alzuguren P; Gomar C; Kramer MG; Kochanek S;
Prieto J; Smerdou C; Qian C

Institution:

Division of Hepatology and Gene Therapy, School of Medicine, Centro de
Investigacion Medica Aplicada, University of Navarra, 31008 Pamplona, Spain.

Journal:

Cancer Res. 2006 Feb 1;66(3):1620-9.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16452221

30.

Survival benefit of transcatheter arterial chemoembolization in patients with
hepatocellular carcinoma larger than 10 cm in diameter.

Authors:

Huang YH; Wu JC; Chen SC; Chen CH; Chiang JH; Huo TI; Lee PC; Chang FY; Lee
SD

Institution:

Division of Gastroenterology, Department of Medicine, Taipei Veterans General
Hospital, Taipei, Taiwan.

Journal:

Aliment Pharmacol Ther. 2006 Jan 1;23(1):129-35.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16393290

www.medifocus.com

(800) 965-3002

31.

Anticarcinogenic impact of interferon on patients with chronic hepatitis C: a
large-scale long-term study in a single center.

Authors:

Ikeda K; Arase Y; Saitoh S; Kobayashi M; Someya T; Hosaka T; Sezaki H; Akuta N;
Suzuki F; Suzuki Y; Kumada H

Institution:

Department of Gastroenterology, Toranomon Hospital, Toranomon 2-2-2, Minato-ku,
Tokyo 105-8470, Japan. ikedakenji@tora.email.ne.jp

Journal:

Intervirology. 2006;49(1-2):82-90.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16166794

32.

Brain metastases from hepatocellular carcinoma in US patients.

Authors:

Seinfeld J; Wagner AS; Kleinschmidt-DeMasters BK

Institution:

Department of Neurosurgery, University of Colorado Health Sciences Center, Denver,
CO, USA.

Journal:

J Neurooncol. 2006 Jan;76(1):93-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16402279

33.

Outcome of patients with fibrolamellar hepatocellular carcinoma.

Authors:

Stipa F; Yoon SS; Liau KH; Fong Y; Jarnagin WR; D'Angelica M; Abou-Alfa G;
Blumgart LH; DeMatteo RP

Institution:

Department of Surgery, San Giovanni Hospital, Rome, Italy.

Journal:

Cancer. 2006 Mar 15;106(6):1331-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16475212

34.

The impact of newer treatment modalities on survival in patients with hepatocellular
carcinoma.

Authors:

Taura N; Hamasaki K; Nakao K; Ichikawa T; Nishimura D; Goto T; Fukuta M;
Kawashimo H; Fujimoto M; Kusumoto K; Motoyoshi Y; Shibata H; Eguchi K

Institution:

First Department of Internal Medicine, Nagasaki University School of Medicine,
Sakamoto, Nagasaki, Japan. ntaura-gi@umin.ac.jp

Journal:

Clin Gastroenterol Hepatol. 2006 Sep;4(9):1177-83. Epub 2006 Aug 8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16901768

www.medifocus.com

(800) 965-3002

35.

Hepatocellular carcinoma in extremely elderly patients: an analysis of clinical
characteristics, prognosis and patient survival.

Authors:

Tsukioka G; Kakizaki S; Sohara N; Sato K; Takagi H; Arai H; Abe T; Toyoda M;
Katakai K; Kojima A; Yamazaki Y; Otsuka T; Matsuzaki Y; Makita F; Kanda D;
Horiuchi K; Hamada T; Kaneko M; Suzuki H; Mori M

Institution:

Department of Medicine and Molecular Science, Gunma University Graduate School of
Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan.

Journal:

World J Gastroenterol. 2006 Jan 7;12(1):48-53.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16440416

36.

Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of
hepatocellular carcinoma < or =4 cm.

Authors:

Wakai T; Shirai Y; Suda T; Yokoyama N; Sakata J; Cruz PV; Kawai H; Matsuda Y;
Watanabe M; Aoyagi Y; Hatakeyama K

Institution:

Division of Digestive and General Surgery, Niigata University Graduate School of
Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.

Journal:

World J Gastroenterol. 2006 Jan 28;12(4):546-52.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16489666

37.

Clinical characteristics and prognosis of pediatric hepatocellular carcinoma.

Authors:

Yu SB; Kim HY; Eo H; Won JK; Jung SE; Park KW; Kim WK

Institution:

Department of Surgery, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, Seoul , 110-744, Korea.

Journal:

World J Surg. 2006 Jan;30(1):43-50.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16369702

www.medifocus.com

(800) 965-3002

38.

Long-term follow-up of interferon monotherapy in 454 consecutive naive patients
infected with hepatitis C virus: multi-course interferon therapy may reduce the risk of
hepatocellular carcinoma and increase survival.

Authors:

Akuta, Norio; Suzuki, Fumitaka; Suzuki, Yoshiyuki; Sezaki, Hitomi; Hosaka, Tetsuya;
Someya, Takashi; Kobayashi, Masahiro; Saitoh, Satoshi; Arase, Yasuji; Ikeda, Kenji;
Kobayashi, Mariko; Kumada, Hiromitsu

Institution:

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
akuta-gi@umin.ac.jp

Journal:

Scand J Gastroenterol 2005 Jun;40(6):688-96.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P16036529

39.

Management of hepatocellular carcinoma.

Authors:

Bruix J; Sherman M

Institution:

BCLC Group. Liver Unit. Hospital Clinic, University of Barcelona, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. bruix@ub.edu

Journal:

Hepatology. 2005 Nov;42(5):1208-36.

Abstract Link:

ABSTRACT NOT AVAILABLE

40.

Comparison of survival rates after bland arterial embolization and ablation versus
surgical resection for treating solitary hepatocellular carcinoma up to 7 cm.

Authors:

Maluccio, Mary; Covey, Anne M; Gandhi, Ripal; Gonen, Mithat; Getrajdman, George
I; Brody, Lynn A; Fong, Yuman; Jarnagin, William; D'Angelica, Michael; Blumgart,
Leslie; DeMatteo, Ronald; Brown, Karen T

Institution:

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New
York 10021, USA.

Journal:

J Vasc Interv Radiol 2005 Jul;16(7):955-61.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P16002503

www.medifocus.com

(800) 965-3002

41.

Comparative study of survival of patients with hepatocellular carcinoma predicted by
different staging systems using multivariate analysis.

Authors:

Nanashima A; Omagari K; Tobinaga S; Shibata K; Sumida Y; Mine M; Morino S;
Shibasaki S; Ide N; Shindou H; Nagayasu T

Institution:

Division of Surgical Oncology, Department of Translational Medical Sciences,
Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto,
Nagasaki 852-8501, Japan.

Journal:

Eur J Surg Oncol. 2005 Oct;31(8):882-90.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=15993031

42.

Gene therapy for hepatocellular carcinoma using sonoporation enhanced by contrast
agents.

Authors:

Sakakima Y; Hayashi S; Yagi Y; Hayakawa A; Tachibana K; Nakao A

Institution:

Department of Surgery II, Nagoya University School of Medicine, Nagoya 466-8550,
Japan. sakakima@med.nagoya-u.ac.jp

Journal:

Cancer Gene Ther. 2005 Nov;12(11):884-9.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=15891773

43.

In vitro and in vivo suppression of growth of hepatocellular carcinoma cells by novel
traditional Chinese medicine-platinum anti-cancer agents.

Authors:

To KK; Ho YP; Au-Yeung SC

Institution:

School of Pharmacy, Chinese University of Hong Kong, Shatin, New Territories, Hong
Kong SAR.

Journal:

Anticancer Drugs. 2005 Sep;16(8):825-35.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16096430

www.medifocus.com

(800) 965-3002

Drug Therapy

44.

Adjuvant chemotherapy for prevention of recurrence of invasive hepatocellular
carcinoma after orthotopic liver transplantation.

Authors:

Bernal E; Montero JL; Delgado M; Fraga E; Costan G; Barrera P; Lopez-Vallejos P;
Solorzano G; Rufian S; Briceno J; Padillo J; Lopez-Cillero P; Marchal T; Muntane J; de
la Mata M

Institution:

Liver Transplant Unit, Reina Sofia University Hospital, Cordoba, Spain.

Journal:

Transplant Proc. 2006 Oct;38(8):2495-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17097979

45.

Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma
as a strategy to improve longterm survival.

Authors:

Bharat A; Brown DB; Crippin JS; Gould JE; Lowell JA; Shenoy S; Desai NM;
Chapman WC

Institution:

Department of Surgery, Section of Abdominal Transplantation, Washington University
School of Medicine, 660 S, Euclid Avenue, St Louis, MO 63110, USA.

Journal:

J Am Coll Surg. 2006 Oct;203(4):411-20. Epub 2006 Aug 17.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17000383

46.

Successful treatment of advanced hepatocellular carcinoma by combined
administration of 5-fluorouracil and pegylated interferon-alpha.

Authors:

Kurokohchi K; Takaguchi K; Kita K; Masaki T; Kuriyama S

Institution:

Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1
Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.

Journal:

World J Gastroenterol. 2005 Sep 14;11(34):5401-3.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16149157

www.medifocus.com

(800) 965-3002

47.

Treatment of hepatocellular carcinoma with major portal vein thrombosis by
combined therapy with subcutaneous interferon-alpha and intra-arterial
5-fluorouracil; role of type 1 interferon receptor expression.

Authors:

Ota H; Nagano H; Sakon M; Eguchi H; Kondo M; Yamamoto T; Nakamura M;
Damdinsuren B; Wada H; Marubashi S; Miyamoto A; Dono K; Umeshita K; Nakamori
S; Wakasa K; Monden M

Institution:

Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka
University, 2-2, Yamadaoka E-2, Suita, Osaka 565-0871, Japan.

Journal:

Br J Cancer. 2005 Sep 5;93(5):557-64.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16106266

48.

Hepatocellular carcinoma and octreotide: treatment results in prospectively assigned
patients with advanced tumor and cirrhosis stage.

Authors:

Plentz RR; Tillmann HL; Kubicka S; Bleck JS; Gebel M; Manns MP; Rudolph KL

Institution:

Department of Gastroenterology, Hepatology and Endocrinology, Medical School of
Hannover, Germany.

Journal:

J Gastroenterol Hepatol. 2005 Sep;20(9):1422-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16105131

49.

Thalidomide in advanced hepatocellular carcinoma with optional low-dose
interferon-alpha2a upon progression.

Authors:

Schwartz JD; Sung M; Schwartz M; Lehrer D; Mandeli J; Liebes L; Goldenberg A;
Volm M

Institution:

Hematology-Oncology, Mount Sinai School of Medicine, New York, New York 10029,
USA. jonathan.schwartz@mssm.edu

Journal:

Oncologist. 2005 Oct;10(9):718-27.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16249352

www.medifocus.com

(800) 965-3002

Surgical Therapy

50.

Risk factors for intrahepatic recurrence after hepatectomy for hepatocellular
carcinoma.

Authors:

Ibrahim S; Roychowdhury A; Hean TK

Institution:

Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Changi,
Singapore 507027. salleh_ibrahim@cgh.com.sg

Journal:

Am J Surg. 2007 Jul;194(1):17-22.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17560903

51.

Repeat hepatectomy for recurrent hepatocellular carcinoma.

Authors:

Itamoto T; Nakahara H; Amano H; Kohashi T; Ohdan H; Tashiro H; Asahara T

Institution:

Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical
Research, Graduate School of Biomedical Science, Hiroshima University, Hiroshima,
Japan. titamoto@hiroshima-u.ac.jp

Journal:

Surgery. 2007 May;141(5):589-97.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17462458

52.

A review of the prognostic factors in patients with recurrence after liver resection for
hepatocellular carcinoma.

Authors:

Kaibori M; Saito T; Matsui Y; Uchida Y; Ishizaki M; Kamiyama Y

Institution:

Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1
Shinmachi, Hirakata, Osaka 573-1191, Japan. kaibori@hirakata.kmu.ac.jp

Journal:

Am J Surg. 2007 Apr;193(4):431-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17368283

www.medifocus.com

(800) 965-3002

53.

Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment,
and outcomes.

Authors:

Shah SA; Cleary SP; Wei AC; Yang I; Taylor BR; Hemming AW; Langer B; Grant DR;
Greig PD; Gallinger S

Institution:

Department of Surgery, Toronto General Hospital, University of Toronto, Toronto,
Canada. shahs01@ummhc.org

Journal:

Surgery. 2007 Mar;141(3):330-9. Epub 2006 Nov 1.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17349844

54.

Trends in morbidity and mortality after hepatic resection for hepatocellular
carcinoma: an institute's experience with 625 patients.

Authors:

Taketomi A; Kitagawa D; Itoh S; Harimoto N; Yamashita Y; Gion T; Shirabe K;
Shimada M; Maehara Y

Institution:

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu
University, Fukuoka, Japan. taketomi@surg2.med.kyushu-u.ac.jp

Journal:

J Am Coll Surg. 2007 Apr;204(4):580-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17382216

55.

Outcomes and recurrence of initially resectable hepatocellular carcinoma meeting
milan criteria: Rationale for partial hepatectomy as first strategy.

Authors:

Tanaka S; Noguchi N; Ochiai T; Kudo A; Nakamura N; Ito K; Kawamura T; Teramoto
K; Arii S

Institution:

Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental
University, Graduate School of Medicine, Tokyo, Japan. shinji.msrg@tmd.ac.jp

Journal:

J Am Coll Surg. 2007 Jan;204(1):1-6. Epub 2006 Nov 28.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17189106

56.

Long-term outcome of resection of large hepatocellular carcinoma.

Authors:

Chen XP; Qiu FZ; Wu ZD; Zhang ZW; Huang ZY; Chen YF

Institution:

Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan 430030, China. chenxp@medmail.com.cn

Journal:

Br J Surg. 2006 May;93(5):600-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16607679

www.medifocus.com

(800) 965-3002

57.

Hepatectomy for huge hepatocellular carcinoma in 634 cases.

Authors:

Chen XP; Qiu FZ; Wu ZD; Zhang BX

Institution:

Hepatic Surgery Center, Tongji Hospital, Medical College, Huazhong University of
Science and Technology, Wuhan 430030, Hubei Province, China.
chenxp_53@sina.com

Journal:

World J Gastroenterol. 2006 Aug 7;12(29):4652-5.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16937434

58.

Risk factors for immediate post-operative fatal recurrence after curative resection of
hepatocellular carcinoma.

Authors:

Kim BW; Kim YB; Wang HJ; Kim MW

Institution:

Department of Surgery, Ajou University School of Medicine, San-5 442-749, Wonchon
dong, Youngtong ku, Kyounggi Province, Suwon, South Korea.

Journal:

World J Gastroenterol. 2006 Jan 7;12(1):99-104.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16440425

59.

Results of 404 hepatic resections including 80 repeat hepatectomies for hepatocellular
carcinoma.

Authors:

Kobayashi A; Kawasaki S; Miyagawa S; Miwa S; Noike T; Takagi S; Iijima S;
Miyagawa Y

Institution:

First Department of Surgery, Shinshu University School of Medicine, Matsumoto,
Japan.

Journal:

Hepatogastroenterology. 2006 Sep-Oct;53(71):736-41.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17086879

60.

Early and late recurrence after liver resection for hepatocellular carcinoma:
prognostic and therapeutic implications.

Authors:

Portolani N; Coniglio A; Ghidoni S; Giovanelli M; Benetti A; Tiberio GA; Giulini SM

Institution:

Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.

Journal:

Ann Surg. 2006 Feb;243(2):229-35.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16432356

www.medifocus.com

(800) 965-3002

61.

Risk of recurrence in a long-term follow-up after surgery in 417 patients with hepatitis
B- or hepatitis C-related hepatocellular carcinoma.

Authors:

Sasaki Y; Yamada T; Tanaka H; Ohigashi H; Eguchi H; Yano M; Ishikawa O; Imaoka
S

Institution:

Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases,
1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. sasaki-yo@mc.pref.osaka.jp

Journal:

Ann Surg. 2006 Nov;244(5):771-80.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17060771

62.

Factors associated with early recurrence after resection for hepatocellular carcinoma
and outcomes.

Authors:

Shah SA; Greig PD; Gallinger S; Cattral MS; Dixon E; Kim RD; Taylor BR; Grant DR;
Vollmer CM

Institution:

Department of Surgery, University Health Network, University of Toronto, Toronto,
ON, Canada. shimul.shah@uhn.on.ca

Journal:

J Am Coll Surg. 2006 Feb;202(2):275-83. Epub 2005 Dec 19.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16427553

63.

Predictive factors affecting early recurrence after hepatectomy for hepatocellular
carcinoma in 5-year survivors.

Authors:

Kaido T; Arii S; Oe H; Mori A; Imamura M

Institution:

Department of Surgery, Otsu Municipal Hospital, Shiga, Japan. kaido3@hotmail.com

Journal:

Hepatogastroenterology. 2005 Sep-Oct;52(65):1484-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16201102

64.

Prognostic factors and longterm survival after hepatic resection for hepatocellular
carcinoma originating from noncirrhotic liver.

Authors:

Laurent C; Blanc JF; Nobili S; Sa Cunha A; le Bail B; Bioulac-Sage P; Balabaud C;
Capdepont M; Saric J

Institution:

Department of Surgery, Saint-Andre Hospital, Bordeaux, France.

Journal:

J Am Coll Surg. 2005 Nov;201(5):656-62. Epub 2005 Aug 31.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16256906

www.medifocus.com

(800) 965-3002

65.

Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma.

Authors:

Liau KH; Ruo L; Shia J; Padela A; Gonen M; Jarnagin WR; Fong Y; D'Angelica MI;
Blumgart LH; DeMatteo RP

Institution:

Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, New York 10021, USA.

Journal:

Cancer. 2005 Nov 1;104(9):1948-55.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16196045

66.

Clinical outcome of 214 liver resections using microwave tissue coagulation.

Authors:

Satoi, Sohei; Kamiyama, Yasuo; Matsui, Yoichi; Kitade, Hiroaki; Kaibori, Masaki;
Yamamoto, Hidekazu; Yanagimoto, Hiroaki; Takai, Soichiro; Kwon, A-Hon

Institution:

Department of Surgery, Kansai Medical University, Osaka, Japan.
satoi@takii.kmu.ac.jp

Journal:

Hepatogastroenterology 2005 Jul-Aug;52(64):1180-5.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P16001657

67.

A long-term follow-up and management study of hepatocellular carcinoma patients
surviving for 10 years or longer after curative hepatectomy.

Authors:

Shimada K; Sano T; Sakamoto Y; Kosuge T

Institution:

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital,
5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. kshimada@ncc.go.jp

Journal:

Cancer. 2005 Nov 1;104(9):1939-47.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16177997

www.medifocus.com

(800) 965-3002

Clinical Trials

68.

Portal vein embolization and autologous CD133+ bone marrow stem cells for liver
regeneration: initial experience.

Authors:

Furst G; Schulte am Esch J; Poll LW; Hosch SB; Fritz LB; Klein M; Godehardt E;
Krieg A; Wecker B; Stoldt V; Stockschlader M; Eisenberger CF; Modder U; Knoefel
WT

Institution:

Institute of Diagnostic Radiology, Heinrich-Heine-University of Duesseldorf,
Moorenstr 5, 40225 Duesseldorf, Germany.

Journal:

Radiology. 2007 Apr;243(1):171-9. Epub 2007 Feb 20.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17312278

69.

Inoperable hepatocellular carcinoma: transarterial 188Re HDD-labeled iodized oil for
treatment--prospective multicenter clinical trial.

Authors:

Kumar A; Srivastava DN; Chau TT; Long HD; Bal C; Chandra P; Chien le T; Hoa NV;
Thulkar S; Sharma S; Tam le H; Xuan TQ; Canh NX; Pant GS; Bandopadhyaya GP

Institution:

Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar,
New Delhi, India.

Journal:

Radiology. 2007 May;243(2):509-19.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17456873

70.

Multiple-electrode radiofrequency ablation of hepatic malignancies: initial clinical
experience.

Authors:

Laeseke PF; Frey TM; Brace CL; Sampson LA; Winter TC 3rd; Ketzler JR; Lee FT Jr

Institution:

Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.

Journal:

AJR Am J Roentgenol. 2007 Jun;188(6):1485-94.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17515366

www.medifocus.com

(800) 965-3002

71.

A randomized, controlled trial of postoperative adjuvant interferon therapy after
resection of hepatocellular carcinoma.

Authors:

Lo CM; Liu CL; Chan SC; Lam CM; Poon RT; Ng IO; Fan ST; Wong J

Institution:

Centre for the Study of Liver Disease and the Department of Surgery, University of
Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
chungmlo@hkucc.hku.hk

Journal:

Ann Surg. 2007 Jun;245(6):831-42.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17522506

72.

Gemcitabine plus oxaliplatin (GEMOX) in patients with advanced hepatocellular
carcinoma (HCC): results of a phase II study.

Authors:

Louafi S; Boige V; Ducreux M; Bonyhay L; Mansourbakht T; de Baere T; Asnacios A;
Hannoun L; Poynard T; Taieb J

Institution:

Service d'Hepato-gastro-enterologie, Groupe Hospitalier Pitie Salpetriere, Paris, France.

Journal:

Cancer. 2007 Apr 1;109(7):1384-90.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17330837

73.

Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor
progression after ablation and ablative margin.

Authors:

Nakazawa T; Kokubu S; Shibuya A; Ono K; Watanabe M; Hidaka H; Tsuchihashi T;
Saigenji K

Institution:

Gastroenterology Division of Internal Medicine, Kitasato University East Hospital,
2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan. tnakazaw@kitasato-u.ac.jp

Journal:

AJR Am J Roentgenol. 2007 Feb;188(2):480-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17242258

74.

Phase II study of sorafenib in patients with advanced hepatocellular carcinoma.

Authors:

Abou-Alfa GK; Schwartz L; Ricci S; Amadori D; Santoro A; Figer A; De Greve J;
Douillard JY; Lathia C; Schwartz B; Taylor I; Moscovici M; Saltz LB

Institution:

Memorial Sloan-Kettering Cancer Center, York, NY 10022, USA. abou-alg@mskcc.org

Journal:

J Clin Oncol. 2006 Sep 10;24(26):4293-300. Epub 2006 Aug 14.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16908937

www.medifocus.com

(800) 965-3002

75.

Survival of patients with early hepatocellular carcinoma treated by percutaneous
alcohol injection.

Authors:

Andriulli A; De Sio I; Brunello F; Salmi A; Solmi L; Facciorusso D; Caturelli E; Perri F

Institution:

Department of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San
Giovanni Rotondo, Italy. a.andriulli@operapadrepio.it

Journal:

Aliment Pharmacol Ther. 2006 May 1;23(9):1329-35.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16629938

76.

Irinotecan as first-line chemotherapy in patients with advanced hepatocellular
carcinoma: a multicenter phase II study with dose adjustment according to baseline
serum bilirubin level.

Authors:

Boige V; Taieb J; Hebbar M; Malka D; Debaere T; Hannoun L; Magherini E; Mignard
D; Poynard T; Ducreux M

Institution:

Gastrointestinal Oncology Unit, Department of Medicine, Institut Gustave Roussy, 39
rue Camille Desmoulins, 94805 Villejuif, France. boige@igr.fr

Journal:

Eur J Cancer. 2006 Mar;42(4):456-9. Epub 2006 Jan 20.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16427779

77.

A phase I/II trial testing immunization of hepatocellular carcinoma patients with
dendritic cells pulsed with four alpha-fetoprotein peptides.

Authors:

Butterfield LH; Ribas A; Dissette VB; Lee Y; Yang JQ; De la Rocha P; Duran SD;
Hernandez J; Seja E; Potter DM; McBride WH; Finn R; Glaspy JA; Economou JS

Institution:

Department of Medicine, Surgery and Immunology, Hillman Cancer Center, University
of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213, USA.
butterfield@upmc.edu

Journal:

Clin Cancer Res. 2006 May 1;12(9):2817-25.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16675576

www.medifocus.com

(800) 965-3002

78.

Do young hepatocellular carcinoma patients have worse prognosis? The paradox of age
as a prognostic factor in the survival of hepatocellular carcinoma patients.

Authors:

Chen CH; Chang TT; Cheng KS; Su WW; Yang SS; Lin HH; Wu SS; Lee CM;
Changchien CS; Chen CJ; Sheu JC; Chen DS; Lu SN

Institution:

Department of Internal Medicine, National Taiwan University Hospital and National
Taiwan University College of Medicine, Taipei, Taiwan.

Journal:

Liver Int. 2006 Sep;26(7):766-73.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16911457

79.

A prospective randomized trial comparing percutaneous local ablative therapy and
partial hepatectomy for small hepatocellular carcinoma.

Authors:

Chen MS; Li JQ; Zheng Y; Guo RP; Liang HH; Zhang YQ; Lin XJ; Lau WY

Institution:

Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen University,
Guangzhou, China. Cms64@21cn.com

Journal:

Ann Surg. 2006 Mar;243(3):321-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16495695

80.

Targeting radioimmunotherapy of hepatocellular carcinoma with iodine (131I)
metuximab injection: clinical phase I/II trials.

Authors:

Chen ZN; Mi L; Xu J; Song F; Zhang Q; Zhang Z; Xing JL; Bian HJ; Jiang JL; Wang
XH; Shang P; Qian AR; Zhang SH; Li L; Li Y; Feng Q; Yu XL; Feng Y; Yang XM;
Tian R; Wu ZB; Leng N; Mo TS; Kuang AR; Tan TZ; Li YC; Liang DR; Lu WS; Miao
J; Xu GH; Zhang ZH; Nan KJ; Han J; Liu QG; Zhang HX; Zhu P

Institution:

Cell Engineering Research Centre and Department of Cell Biology, State Key
Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.

Journal:

Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):435-44.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16690431

www.medifocus.com

(800) 965-3002

81.

Preliminary experience with arterial chemoembolization for hepatoblastoma and
hepatocellular carcinoma in children.

Authors:

Czauderna P; Zbrzezniak G; Narozanski W; Korzon M; Wyszomirska M; Stoba C

Institution:

Department of Pediatric Surgery, Medical University of Gdansk, Gdansk, Poland.
pczaud@amg.gda.pl

Journal:

Pediatr Blood Cancer. 2006 Jun;46(7):825-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16123986

82.

Uracil-tegafur as an adjuvant for hepatocellular carcinoma: a randomized trial.

Authors:

Hasegawa K; Takayama T; Ijichi M; Matsuyama Y; Imamura H; Sano K; Sugawara Y;
Kokudo N; Makuuchi M

Institution:

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of
Tokyo, Japan.

Journal:

Hepatology. 2006 Oct;44(4):891-5.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17006925

83.

Results of three-dimensional conformal radiotherapy and thalidomide for advanced
hepatocellular carcinoma.

Authors:

Hsu WC; Chan SC; Ting LL; Chung NN; Wang PM; Ying KS; Shin JS; Chao CJ; Lin
GD

Institution:

Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan.

Journal:

Jpn J Clin Oncol. 2006 Feb;36(2):93-9.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16517834

84.

A randomized controlled study of preemptive lamivudine in patients receiving
transarterial chemo-lipiodolization.

Authors:

Jang JW; Choi JY; Bae SH; Yoon SK; Chang UI; Kim CW; Cho SH; Han JY; Lee YS

Institution:

Department of Internal Medicine, College of Medicine, WHO Collaborating Center on
Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.

Journal:

Hepatology. 2006 Feb;43(2):233-40.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16440357

www.medifocus.com

(800) 965-3002

85.

Long-term clinical outcome of phase IIb clinical trial of percutaneous injection with
holmium-166/chitosan complex (Milican) for the treatment of small hepatocellular
carcinoma.

Authors:

Kim JK; Han KH; Lee JT; Paik YH; Ahn SH; Lee JD; Lee KS; Chon CY; Moon YM

Institution:

Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei Liver
Cancer Study Group, Yonsei University College of Medicine, 134 Shinchoin-dong,
Seodaemoon-gu, Seoul, Korea 120-752.

Journal:

Clin Cancer Res. 2006 Jan 15;12(2):543-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16428498

86.

Phase II study with a combination of epirubicin, cisplatin, UFT, and leucovorin in
advanced hepatocellular carcinoma.

Authors:

Kim SJ; Seo HY; Choi JG; Sul HR; Sung HJ; Park KH; Choi IK; Oh SC; Yoon SY; Seo
JH; Choi CW; Kim BS; Shin SW; Kim YH; Kim JS

Institution:

Division of Hematology/Oncology Department of Internal Medicine, Korea University
Medical Center, 126-1, Anam-dong 5-ga, Sungbuk-ku, Seoul, 136-705, Korea.

Journal:

Cancer Chemother Pharmacol. 2006 Apr;57(4):436-42. Epub 2005 Jul 28.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16049620

87.

Three-dimensional conformal radiotherapy of unresectable hepatocellular carcinoma
patients for whom transcatheter arterial chemoembolization was ineffective or
unsuitable.

Authors:

Kim TH; Kim DY; Park JW; Kim YI; Kim SH; Park HS; Lee WJ; Park SJ; Hong EK;
Kim CM

Institution:

Research Institute and Hospital, National Cancer Center, Goyang, Korea.

Journal:

Am J Clin Oncol. 2006 Dec;29(6):568-75.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17148993

www.medifocus.com

(800) 965-3002

88.

Chemoocclusion vs chemoperfusion for treatment of advanced hepatocellular
carcinoma: a randomised trial.

Authors:

Kirchhoff TD; Rudolph KL; Layer G; Chavan A; Greten TF; Rosenthal H; Kubicka S;
Galanski M; Manns MP; Schild H; Gallkowski U

Institution:

Department of Diagnostic Radiology, Hannover Medical School, OE 8220, D-30625
Hannover, and Department of Radiology, University Hospital, Bonn, Germany.
kirchhoff.timm@mh-hannover.de

Journal:

Eur J Surg Oncol. 2006 Mar;32(2):201-7. Epub 2005 Dec 20.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16373084

89.

Prevention of hepatocellular carcinoma recurrence with alpha-interferon after liver
resection in HCV cirrhosis.

Authors:

Mazzaferro V; Romito R; Schiavo M; Mariani L; Camerini T; Bhoori S; Capussotti L;
Calise F; Pellicci R; Belli G; Tagger A; Colombo M; Bonino F; Majno P; Llovet JM

Institution:

Department of Surgery, Biomedical Statistics, Pathology, National Cancer Institute of
Milan and Chair of Gastroenterology, Policlinico Foundation, Department of Medicine,
University of Milan, Italy. vincenzo.mazzaferro@istitutotumori.mi.it

Journal:

Hepatology. 2006 Dec;44(6):1543-54.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17133492

90.

Combination therapy of intraarterial 5-fluorouracil and systemic interferon-alpha for
advanced hepatocellular carcinoma with portal venous invasion.

Authors:

Obi S; Yoshida H; Toune R; Unuma T; Kanda M; Sato S; Tateishi R; Teratani T; Shiina
S; Omata M

Institution:

Department of Hepatology, Kyoundo Hospital, Tokyo, Japan.
obi-shun@imail.plala.or.jp

Journal:

Cancer. 2006 May 1;106(9):1990-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16565970

www.medifocus.com

(800) 965-3002

91.

Phase I and pharmacokinetic study of oral thalidomide in patients with advanced
hepatocellular carcinoma.

Authors:

Shiah HS; Chao Y; Chen LT; Yao TJ; Huang JD; Chang JY; Chen PJ; Chuang TR;
Chin YH; Whang-Peng J; Liu TW

Institution:

Division of Cancer Research, National Health Research Institutes, Ward 191 Veterans
General Hospital, Taipei, and Department of Internal Medicine, Kaohsiung Medical
University Hospital, Taiwan, ROC.

Journal:

Cancer Chemother Pharmacol. 2006 Nov;58(5):654-64. Epub 2006 Mar 7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16520988

92.

Randomized controlled trial of tamoxifen in advanced hepatocellular carcinoma.

Authors:

Barbare, Jean-Claude; Bouche, Olivier; Bonnetain, Franck; Raoul, Jean-Luc; Rougier,
Philippe; Abergel, Armand; Boige, Valerie; Denis, Bernard; Blanchi, Alain; Pariente,
Alexandre; Milan, Chantal; Bedenne, Laurent

Institution:

Service d'Hepato-Gastroenterologie, Centre Hospitalier, 8 avenue Henri Adnot, 60321
Compiegne, France. jcbarbare001@ch-compiegne.rss.fr

Journal:

J Clin Oncol 2005 Jul 1;23(19):4338-46.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P15994145

93.

Pharmacokinetic and clinical phase II trial of imatinib in patients with impaired liver
function and advanced hepatocellular carcinoma.

Authors:

Eckel F; von Delius S; Mayr M; Dobritz M; Fend F; Hosius C; Schleyer E;
Schulte-Frohlinde E; Schmid RM; Lersch C

Institution:

Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of
Munich, Germany. florian.eckel@lrz.tum.de

Journal:

Oncology. 2005;69(5):363-71. Epub 2005 Nov 24.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16319507

www.medifocus.com

(800) 965-3002

94.

Percutaneous ethanol injection versus surgical resection for the treatment of small
hepatocellular carcinoma: a prospective study.

Authors:

Huang, Guan-Tarn; Lee, Po-Huang; Tsang, Yuk-Ming; Lai, Ming-Yang; Yang,
Pei-Ming; Hu, Rey-Heng; Chen, Pei-Jer; Kao, Jia-Horng; Sheu, Jin-Chuan; Lee,
Cha-Ze; Chen, Ding-Shinn

Institution:

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Journal:

Ann Surg 2005 Jul;242(1):36-42.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P15973099

95.

Randomised controlled trial comparing percutaneous radiofrequency thermal
ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to
treat hepatocellular carcinoma of 3 cm or less.

Authors:

Lin, S-M; Lin, C-J; Lin, C-C; Hsu, C-W; Chen, Y-C

Institution:

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199
Tung Hwa North Rd, Taipei, Taiwan. lsmpaicyto@cgmh.org.tw

Journal:

Gut 2005 Aug;54(8):1151-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P16009687

96.

Phase II study of Erlotinib (OSI-774) in patients with advanced hepatocellular cancer.

Authors:

Philip PA; Mahoney MR; Allmer C; Thomas J; Pitot HC; Kim G; Donehower RC; Fitch
T; Picus J; Erlichman C

Institution:

Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
philipp@karmanos.org

Journal:

J Clin Oncol. 2005 Sep 20;23(27):6657-63.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16170173

97.

Pegylated liposomal doxorubicin-based combination chemotherapy as salvage
treatment in patients with advanced hepatocellular carcinoma.

Authors:

Poh SB; Bai LY; Chen PM

Institution:

Division of Medical Oncology, Department of Medicine, Taipei Veterans General
Hospital, and the National Yang-Ming University Taipei, Taiwan.

Journal:

Am J Clin Oncol. 2005 Dec;28(6):540-6.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16317261

www.medifocus.com

(800) 965-3002

98.

A randomized phase III study of doxorubicin versus cisplatin/interferon
alpha-2b/doxorubicin/fluorouracil (PIAF) combination chemotherapy for unresectable
hepatocellular carcinoma.

Authors:

Yeo W; Mok TS; Zee B; Leung TW; Lai PB; Lau WY; Koh J; Mo FK; Yu SC; Chan
AT; Hui P; Ma B; Lam KC; Ho WM; Wong HT; Tang A; Johnson PJ

Institution:

Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong SAR, China.

Journal:

J Natl Cancer Inst. 2005 Oct 19;97(20):1532-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16234567

99.

Natural history of untreated nonsurgical hepatocellular carcinoma.

Authors:

Yeung YP; Lo CM; Liu CL; Wong BC; Fan ST; Wong J

Institution:

Department of Surgery, Kwong Wah Hospital, and Centre for the Study of Liver
Disease, China.

Journal:

Am J Gastroenterol. 2005 Sep;100(9):1995-2004.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16128944

www.medifocus.com

(800) 965-3002

Radiation Therapy

100.

Three-dimensional conformal radiotherapy for the treatment of arteriovenous
shunting in patients with hepatocellular carcinoma.

Authors:

Hsu HC; Chen TY; Chiu KW; Huang EY; Leung SW; Huang YJ; Wang CY

Institution:

Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsung
Medical Center, 123, Ta-Pei Road, Niao Sung Hsian, Kaohsiung 807, Taiwan.
hsuan5@ms65.hinet.net

Journal:

Br J Radiol. 2007 Jan;80(949):38-42. Epub 2006 Sep 13.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16971419

101.

External beam radiotherapy to treat intra- and extra-hepatic dissemination of
hepatocellular carcinoma after radiofrequency thermal ablation.

Authors:

Yamashita H; Nakagawa K; Shiraishi K; Tago M; Igaki H; Nakamura N; Sasano N;
Shiina S; Omata M; Ohtomo K

Institution:

Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
yamashitah-rad@h.u-tokyo.ac.jp

Journal:

J Gastroenterol Hepatol. 2006 Oct;21(10):1555-60.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16928216

102.

Adverse hepatic events caused by radiotherapy for advanced hepatocellular
carcinoma.

Authors:

Furuse J; Ishii H; Nagase M; Kawashima M; Ogino T; Yoshino M

Institution:

Division of Hepatobiliary and Pancreatic Medical Oncology, National Cancer Center
Hospital East, Chiba, Japan. jfuruse@east.ncc.go.jp

Journal:

J Gastroenterol Hepatol. 2005 Oct;20(10):1512-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16174067

www.medifocus.com

(800) 965-3002

103.

Three-dimensional conformal radiotherapy for portal vein thrombosis of
hepatocellular carcinoma.

Authors:

Kim, Dae Yong; Park, Won; Lim, Do Hoon; Lee, Joon Hyoek; Yoo, Byung Chul; Paik,
Seung Woon; Kho, Kwang Cheol; Kim, Tae Hyun; Ahn, Yong Chan; Huh, Seung Jae

Institution:

Research Institute and Hospital, National Cancer Center, Gyeonggi, Korea.

Journal:

Cancer 2005 Jun 1;103(11):2419-26.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=P15822130

www.medifocus.com

(800) 965-3002

Liver Transplantation

104.

Living donor versus deceased donor liver transplantation for early irresectable
hepatocellular carcinoma.

Authors:

Lo CM; Fan ST; Liu CL; Chan SC; Ng IO; Wong J

Institution:

Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102
Pokfulam Road, Hong Kong, China. chungmlo@hkucc.hku.hk

Journal:

Br J Surg. 2007 Jan;94(1):78-86.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17016793

105.

Preoperative assessment of hepatocellular carcinoma tumor grade using needle biopsy:
implications for transplant eligibility.

Authors:

Pawlik TM; Gleisner AL; Anders RA; Assumpcao L; Maley W; Choti MA

Institution:

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
22187-6681, USA. tpawlik1@jhmi.edu

Journal:

Ann Surg. 2007 Mar;245(3):435-42.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17435551

106.

Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma
fulfilling the Milan criteria treated by resection and transplantation: impact on
long-term survival.

Authors:

Poon RT; Fan ST; Lo CM; Liu CL; Wong J

Institution:

Centre for the Study of Liver Disease and Department of Surgery, University of Hong
Kong, Pokfulam, Hong Kong, China. poontp@hkucc.hku.hk

Journal:

Ann Surg. 2007 Jan;245(1):51-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17197965

www.medifocus.com

(800) 965-3002

107.

Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma:
validation of a uniform staging after surgical treatment.

Authors:

Vauthey JN; Ribero D; Abdalla EK; Jonas S; Bharat A; Schumacher G; Lerut J;
Chapman WC; Hemming AW; Neuhaus P

Institution:

Department of Surgical Oncology, University of Texas MD Anderson Cancer Center,
Houston, TX 77030, USA.

Journal:

J Am Coll Surg. 2007 May;204(5):1016-27; discussion 1027-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17481532

www.medifocus.com

(800) 965-3002

Radiofrequency Ablation

108.

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a
comparative study.

Authors:

Chow DH; Sinn LH; Ng KK; Lam CM; Yuen J; Fan ST; Poon RT

Institution:

Department of Surgery, Centre for the Study of Liver Disease, The University of Hong
Kong, Pokfulam, Hong Kong, China.

Journal:

J Surg Oncol. 2006 Dec 1;94(7):565-71.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17048238

109.

Radiofrequency ablation for hepatocellular carcinoma and liver metastases: experience
in Hospital La Paz.

Authors:

Gomez Senent S; Gomez Raposo C; Mancenido Marcos N; Martin Chavarri S; Carrion
Alonso G; Olveira Martin A; Segura Cabral JM; Gonzalez Baron M

Institution:

Department of Gastroenterology, La Paz University Hospital, Madrid, Spain.
silviagsenent@yahoo.es

Journal:

Clin Transl Oncol. 2006 Sep;8(9):688-91.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17005472

110.

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations.

Authors:

Teratani T; Yoshida H; Shiina S; Obi S; Sato S; Tateishi R; Mine N; Kondo Y; Kawabe
T; Omata M

Institution:

Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Japan.

Journal:

Hepatology. 2006 May;43(5):1101-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16628706

111.

Percutaneous thermal ablation for recurrent hepatocellular carcinoma after
hepatectomy.

Authors:

Lu MD; Yin XY; Xie XY; Xu HX; Xu ZF; Liu GJ; Kuang M; Zheng YL

Institution:

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou 510080, China. lumd@21cn.com

Journal:

Br J Surg. 2005 Nov;92(11):1393-8.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16044409

www.medifocus.com

(800) 965-3002

112.

Intraoperative radiofrequency thermal ablation combined with portal vein infusion
chemotherapy and transarterial chemoembolization for unresectable HCC.

Authors:

Shen SQ; Xiang JJ; Xiong CL; Wu SM; Zhu SS

Institution:

Department of Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei
Province, China. swsw2218@hotmail.com

Journal:

Hepatogastroenterology. 2005 Sep-Oct;52(65):1403-7.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16201083

113.

Prognostic factors for long-term outcome after percutaneous thermal ablation for
hepatocellular carcinoma: a survival analysis of 137 consecutive patients.

Authors:

Xu HX; Lu MD; Xie XY; Yin XY; Kuang M; Chen JW; Xu ZF; Liu GJ

Institution:

Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-Sen University,
Guangzhou, People's Republic of China.

Journal:

Clin Radiol. 2005 Sep;60(9):1018-25.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16124984

www.medifocus.com

(800) 965-3002

Arterial Embolization

114.

Tumor size and operative risks of extended right-sided hepatic resection for
hepatocellular carcinoma: implication for preoperative portal vein embolization.

Authors:

Chik BH; Liu CL; Fan ST; Lo CM; Poon RT; Lam CM; Wong J

Institution:

Centre for the Study of Liver Disease and Department of Surgery, The University of
Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China.

Journal:

Arch Surg. 2007 Jan;142(1):63-9; discussion 69.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17224502

115.

Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular
carcinoma: downstaging to resection, RFA and bridge to transplantation.

Authors:

Kulik LM; Atassi B; van Holsbeeck L; Souman T; Lewandowski RJ; Mulcahy MF;
Hunter RD; Nemcek AA Jr; Abecassis MM; Haines KG 3rd; Salem R

Institution:

Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern
Memorial Hospital, Chicago, Illinois, USA.

Journal:

J Surg Oncol. 2006 Dec 1;94(7):572-86.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17048240

116.

Treatment outcomes for hepatocellular carcinoma using chemoembolization in
combination with other therapies.

Authors:

Marelli L; Stigliano R; Triantos C; Senzolo M; Cholongitas E; Davies N; Yu D; Meyer
T; Patch DW; Burroughs AK

Institution:

Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond
Street, NW3 2QG London, UK. marellilaura@tiscali.it

Journal:

Cancer Treat Rev. 2006 Dec;32(8):594-606. Epub 2006 Oct 11.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17045407

www.medifocus.com

(800) 965-3002

117.

Thermal ablation therapy for hepatocellular carcinoma: comparison between
radiofrequency ablation and percutaneous microwave coagulation therapy.

Authors:

Ohmoto K; Yoshioka N; Tomiyama Y; Shibata N; Kawase T; Yoshida K; Kuboki M;
Yamamoto S

Institution:

Division of Hepatology, Department of Medicine, Kawasaki Medical School, Okayama,
Japan. ohmotok@med.kawasaki-m.ac.jp

Journal:

Hepatogastroenterology. 2006 Sep-Oct;53(71):651-4.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17086861

118.

Radioembolization using 90Y-resin microspheres for patients with advanced
hepatocellular carcinoma.

Authors:

Sangro B; Bilbao JI; Boan J; Martinez-Cuesta A; Benito A; Rodriguez J; Panizo A; Gil
B; Inarrairaegui M; Herrero I; Quiroga J; Prieto J

Institution:

Liver Unit, Department of Internal Medicine, Clinica Universitaria de Navarra,
Pamplona, Spain. bsangro@unav.es

Journal:

Int J Radiat Oncol Biol Phys. 2006 Nov 1;66(3):792-800. Epub 2006 Aug 14.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16904840

119.

Diaphragmatic weakness after transcatheter arterial chemoembolization of inferior
phrenic artery for treatment of hepatocellular carcinoma.

Authors:

Shin SW; Do YS; Choo SW; Lieu WC; Cho SK; Park KB; Yoo BC; Kang EH; Choo
IW

Institution:

Department of Radiology and Center for Imaging Sciences, Division of
Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of
Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.

Journal:

Radiology. 2006 Nov;241(2):581-8. Epub 2006 Sep 27.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=17005772

www.medifocus.com

(800) 965-3002

120.

Prospective cohort study of transarterial chemoembolization for unresectable
hepatocellular carcinoma in 8510 patients.

Authors:

Takayasu K; Arii S; Ikai I; Omata M; Okita K; Ichida T; Matsuyama Y; Nakanuma Y;
Kojiro M; Makuuchi M; Yamaoka Y

Institution:

Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
ktakayas@ncc.go.jp

Journal:

Gastroenterology. 2006 Aug;131(2):461-9.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16890600

121.

Percutaneous ethanol injection for small hepatocellular carcinoma: therapeutic
efficacy based on 20-year observation.

Authors:

Ebara M; Okabe S; Kita K; Sugiura N; Fukuda H; Yoshikawa M; Kondo F; Saisho H

Institution:

Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba
University, 1-8-1 Inohana, Chiba-shi, Chiba 260-8670, Japan. ebara@faculty.chiba-u.jp

Journal:

J Hepatol. 2005 Sep;43(3):458-64.

Abstract Link:

http://www.medifocus.com/abstracts.php?gid=OC031&ID=16005538

www.medifocus.com

(800) 965-3002

4 - Centers of Research

This section of your MediFocus Guidebook is a unique directory of doctors, researchers, medical centers,
and research institutions with specialized research interest, and in many cases, clinical expertise in the
management of this specific medical condition. The Centers of Research directory is a valuable resource for
quickly identifying and locating leading medical authorities and medical institutions within the United
States and other countries that are considered to be at the forefront in clinical research and treatment of this
disorder.

Use the Centers of Research directory to contact, consult, or network with leading experts in the field and to
locate a hospital or medical center that can help you.

The following information is provided in the Centers of Research directory:

• Geographic Location

• United States: the information is divided by individual states listed in alphabetical order. Not all

states may be included.

• Other Countries: information is presented for select countries worldwide listed in alphabetical

order. Not all countries may be included.

• Names of Authors

• Select names of individual authors (doctors, researchers, or other health-care professionals) with

specialized research interest, and in many cases, clinical expertise in the management of this
specific medical condition, who have recently published articles in leading medical journals
about the condition.

• E-mail addresses for individual authors, if listed on their specific publications, is also provided.

• Institutional Affiliations

• Next to each individual author's name is their institutional affiliation (hospital, medical center,

or research institution) where the study was conducted as listed in their publication(s).

• In many cases, information about the specific department within the medical institution where

the individual author was located at the time the study was conducted is also provided.

www.medifocus.com

(800) 965-3002

Centers of Research

United States

CO - Colorado

Name of Author

Institutional Affiliation

Kleinschmidt-De
Masters BK

Department of Neurosurgery, University of Colorado Health Sciences
Center, Denver, CO, USA.

Seinfeld J

Department of Neurosurgery, University of Colorado Health Sciences
Center, Denver, CO, USA.

IL - Illinois

Name of Author

Institutional Affiliation

Kulik LM

Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center,
Northwestern Memorial Hospital, Chicago, Illinois, USA.

Salem R

Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center,
Northwestern Memorial Hospital, Chicago, Illinois, USA.

MA - Massachussetts

Name of Author

Institutional Affiliation

Chung RT

Department of Medicine, Massachusetts General Hospital, Boston,
Massachusetts.

Pekow JR

Department of Medicine, Massachusetts General Hospital, Boston,
Massachusetts.

Sahani DV

Department of Abdominal Imaging and Interventional Radiology,
Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114,
USA. dsahani@partners.org

Zhu AX

Department of Abdominal Imaging and Interventional Radiology,
Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114,
USA. dsahani@partners.org

MD - Maryland

Name of Author

Institutional Affiliation

Choti MA

Department of Surgery, Johns Hopkins University School of Medicine,
Baltimore, MD 22187-6681, USA. tpawlik1@jhmi.edu

Pawlik TM

Department of Surgery, Johns Hopkins University School of Medicine,
Baltimore, MD 22187-6681, USA. tpawlik1@jhmi.edu

www.medifocus.com

(800) 965-3002

MI - Michigan

Name of Author

Institutional Affiliation

Erlichman C

Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201,
USA. philipp@karmanos.org

Marrero JA

University of Michigan, Ann Arbor, 48109, USA. jmarrero@umich.edu

Philip PA

Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201,
USA. philipp@karmanos.org

MN - Minnesota

Name of Author

Institutional Affiliation

Gores GJ

Mayo Clinic College of Medicine, Miles and Shirley Fiterman Center for
Digestive Diseases, 200 First Street SW, Rochester, MN 55905, USA.
Roberts.Lewis@mayo.edu

Roberts LR

Mayo Clinic College of Medicine, Miles and Shirley Fiterman Center for
Digestive Diseases, 200 First Street SW, Rochester, MN 55905, USA.
Roberts.Lewis@mayo.edu

MO - Missouri

Name of Author

Institutional Affiliation

Bharat A

Department of Surgery, Section of Abdominal Transplantation, Washington
University School of Medicine, 660 S, Euclid Avenue, St Louis, MO 63110,
USA.

Chapman WC

Department of Surgery, Section of Abdominal Transplantation, Washington
University School of Medicine, 660 S, Euclid Avenue, St Louis, MO 63110,
USA.

NE - Nebraska

Name of Author

Institutional Affiliation

Botha JF

Department of Surgery, Section of Transplantation, UNMC Eppley Cancer
Center at The Nebraska Medical Center, Omaha, NE 68198-3285.
jbotha@unmc.edu

Langnas AN

Department of Surgery, Section of Transplantation, UNMC Eppley Cancer
Center at The Nebraska Medical Center, Omaha, NE 68198-3285.
jbotha@unmc.edu

www.medifocus.com

(800) 965-3002

NY - New York

Name of Author

Institutional Affiliation

Abou-Alfa GK

Memorial Sloan-Kettering Cancer Center, York, NY 10022, USA.
abou-alg@mskcc.org

Brown, Karen T

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New
York, New York 10021, USA.

DeMatteo RP

Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, New York 10021, USA.

Liau KH

Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, New York 10021, USA.

Llovet J

Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine,
New York, USA. myron.schwartz@mssm.edu

Maluccio, Mary

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New
York, New York 10021, USA.

Milind J

Department of Medicine, Roswell Park Cancer Institute and State University
of New York at Buffalo, NY 14263, USA. ailawadhi77@yahoo.com

Saltz LB

Memorial Sloan-Kettering Cancer Center, York, NY 10022, USA.
abou-alg@mskcc.org

Schwartz JD

Hematology-Oncology, Mount Sinai School of Medicine, New York, New
York 10029, USA. jonathan.schwartz@mssm.edu

Schwartz M

Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine,
New York, USA. myron.schwartz@mssm.edu

Sikander A

Department of Medicine, Roswell Park Cancer Institute and State University
of New York at Buffalo, NY 14263, USA. ailawadhi77@yahoo.com

Volm M

Hematology-Oncology, Mount Sinai School of Medicine, New York, New
York 10029, USA. jonathan.schwartz@mssm.edu

PA - Pennsylvania

Name of Author

Institutional Affiliation

Arciero CA

Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia,
Pennsylvania 19111, USA.

Butterfield LH

Department of Medicine, Surgery and Immunology, Hillman Cancer Center,
University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213,
USA. butterfield@upmc.edu

Economou JS

Department of Medicine, Surgery and Immunology, Hillman Cancer Center,
University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213,
USA. butterfield@upmc.edu

Sigurdson ER

Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia,
Pennsylvania 19111, USA.

www.medifocus.com

(800) 965-3002

TX - Texas

Name of Author

Institutional Affiliation

Abbruzzese JL

Department of Gastrointestinal Medical Oncology, The University of Texas
MD Anderson Cancer Center, Houston, 77030, USA.
methomas@mdanderson.org

El-Serag HB

Section of Health Services Research, Houston Veterans Affairs Medical
Center, Baylor College of Medicine, 2002 Holcombe Boulevard (152),
Houston, TX 77030, USA. hasheme@bcm.tmc.edu

Hyman D

Department of Medicine, Baylor College of Medicine, Houston, Tex, USA.
parikh@bcm.tmc.edu

McGlynn KA

Section of Health Services Research, Houston Veterans Affairs Medical
Center, Baylor College of Medicine, 2002 Holcombe Boulevard (152),
Houston, TX 77030, USA. hasheme@bcm.tmc.edu

Neuhaus P

Department of Surgical Oncology, University of Texas MD Anderson Cancer
Center, Houston, TX 77030, USA.

Parikh S

Department of Medicine, Baylor College of Medicine, Houston, Tex, USA.
parikh@bcm.tmc.edu

Thomas MB

Department of Gastrointestinal Medical Oncology, The University of Texas
MD Anderson Cancer Center, Houston, 77030, USA.
methomas@mdanderson.org

Vauthey JN

Department of Surgical Oncology, University of Texas MD Anderson Cancer
Center, Houston, TX 77030, USA.

WI - Wisconsin

Name of Author

Institutional Affiliation

Laeseke PF

Department of Biomedical Engineering, University of Wisconsin, Madison,
WI, USA.

Lee FT Jr

Department of Biomedical Engineering, University of Wisconsin, Madison,
WI, USA.

www.medifocus.com

(800) 965-3002

Centers of Research

Other Countries

Australia

Name of Author

Institutional Affiliation

Maddern GJ

Australian Safety and Efficacy Register of New Interventional
Procedures-Surgical, Royal Australasian College of Surgeons, Stepney.

Sutherland LM

Australian Safety and Efficacy Register of New Interventional
Procedures-Surgical, Royal Australasian College of Surgeons, Stepney.

Canada

Name of Author

Institutional Affiliation

Gallinger S

Department of Surgery, Toronto General Hospital, University of Toronto,
Toronto, Canada. shahs01@ummhc.org

Shah SA

Department of Surgery, University Health Network, University of Toronto,
Toronto, ON, Canada. shimul.shah@uhn.on.ca

Vollmer CM

Department of Surgery, University Health Network, University of Toronto,
Toronto, ON, Canada. shimul.shah@uhn.on.ca

China

Name of Author

Institutional Affiliation

Chen MS

Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen
University, Guangzhou, China. Cms64@21cn.com

Chen XP

Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan 430030, China.
chenxp@medmail.com.cn

Chen YF

Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan 430030, China.
chenxp@medmail.com.cn

Chen ZN

Cell Engineering Research Centre and Department of Cell Biology, State
Key Laboratory of Cancer Biology, Fourth Military Medical University,
Xi'an, China.

Jiang GL

Department of Integrative Chinese and Western Medicine, Fudan University
Cancer Hospital, Shanghai 200032, China.

Lau WY

Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen
University, Guangzhou, China. Cms64@21cn.com

www.medifocus.com

(800) 965-3002

Liu GJ

Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, People's Republic of China.

Lu MD

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou 510080, China. lumd@21cn.com

Shen SQ

Department of Surgery, Renmin Hospital of Wuhan University, Wuhan
430060, Hubei Province, China. swsw2218@hotmail.com

Wong J

Department of Surgery, Kwong Wah Hospital, and Centre for the Study of
Liver Disease, China.

Xu HX

Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, People's Republic of China.

Yeung YP

Department of Surgery, Kwong Wah Hospital, and Centre for the Study of
Liver Disease, China.

Zhang BX

Hepatic Surgery Center, Tongji Hospital, Medical College, Huazhong
University of Science and Technology, Wuhan 430030, Hubei Province,
China. chenxp_53@sina.com

Zheng YL

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou 510080, China. lumd@21cn.com

Zhou ZH

Department of Integrative Chinese and Western Medicine, Fudan University
Cancer Hospital, Shanghai 200032, China.

Zhu P

Cell Engineering Research Centre and Department of Cell Biology, State
Key Laboratory of Cancer Biology, Fourth Military Medical University,
Xi'an, China.

Zhu SS

Department of Surgery, Renmin Hospital of Wuhan University, Wuhan
430060, Hubei Province, China. swsw2218@hotmail.com

France

Name of Author

Institutional Affiliation

Barbare,
Jean-Claude

Service d'Hepato-Gastroenterologie, Centre Hospitalier, 8 avenue Henri
Adnot, 60321 Compiegne, France. jcbarbare001@ch-compiegne.rss.fr

Bedenne, Laurent

Service d'Hepato-Gastroenterologie, Centre Hospitalier, 8 avenue Henri
Adnot, 60321 Compiegne, France. jcbarbare001@ch-compiegne.rss.fr

Boige V

Gastrointestinal Oncology Unit, Department of Medicine, Institut Gustave
Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France. boige@igr.fr

Ducreux M

Gastrointestinal Oncology Unit, Department of Medicine, Institut Gustave
Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France. boige@igr.fr

Laurent C

Department of Surgery, Saint-Andre Hospital, Bordeaux, France.

Louafi S

Service d'Hepato-gastro-enterologie, Groupe Hospitalier Pitie Salpetriere,
Paris, France.

Saric J

Department of Surgery, Saint-Andre Hospital, Bordeaux, France.

www.medifocus.com

(800) 965-3002

Taieb J

Service d'Hepato-gastro-enterologie, Groupe Hospitalier Pitie Salpetriere,
Paris, France.

Germany

Name of Author

Institutional Affiliation

Bitzer M

Department of Internal Medicine I, Medical University Clinic, Tubingen,
Germany.

Eckel F

Department of Internal Medicine II, Klinikum rechts der Isar, Technical
University of Munich, Germany. florian.eckel@lrz.tum.de

Furst G

Institute of Diagnostic Radiology, Heinrich-Heine-University of Duesseldorf,
Moorenstr 5, 40225 Duesseldorf, Germany.

Gallkowski U

Department of Diagnostic Radiology, Hannover Medical School, OE 8220,
D-30625 Hannover, and Department of Radiology, University Hospital,
Bonn, Germany. kirchhoff.timm@mh-hannover.de

Kirchhoff TD

Department of Diagnostic Radiology, Hannover Medical School, OE 8220,
D-30625 Hannover, and Department of Radiology, University Hospital,
Bonn, Germany. kirchhoff.timm@mh-hannover.de

Knoefel WT

Institute of Diagnostic Radiology, Heinrich-Heine-University of Duesseldorf,
Moorenstr 5, 40225 Duesseldorf, Germany.

Lersch C

Department of Internal Medicine II, Klinikum rechts der Isar, Technical
University of Munich, Germany. florian.eckel@lrz.tum.de

Plentz RR

Department of Gastroenterology, Hepatology and Endocrinology, Medical
School of Hannover, Germany.

Rudolph KL

Department of Gastroenterology, Hepatology and Endocrinology, Medical
School of Hannover, Germany.

Venturelli S

Department of Internal Medicine I, Medical University Clinic, Tubingen,
Germany.

Hong Kong

Name of Author

Institutional Affiliation

Au-Yeung SC

School of Pharmacy, Chinese University of Hong Kong, Shatin, New
Territories, Hong Kong SAR.

Chik BH

Centre for the Study of Liver Disease and Department of Surgery, The
University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road,
Pokfulam, Hong Kong, China.

Chok KS

Departments of Surgery and Radiology, Centre for the Study of Liver
Disease, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam
Road, Pokfulam, Hong Kong.

Chow DH

Department of Surgery, Centre for the Study of Liver Disease, The
University of Hong Kong, Pokfulam, Hong Kong, China.

www.medifocus.com

(800) 965-3002

Fan ST

Departments of Surgery and Radiology, Centre for the Study of Liver
Disease, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam
Road, Pokfulam, Hong Kong.

Johnson PJ

Department of Clinical Oncology, Chinese University of Hong Kong, Prince
of Wales Hospital, Shatin, Hong Kong SAR, China.

Lau WY

Department of Surgery, Prince of Wales Hospital, The Chinese University of
Hong Kong, HKSAR, China.

Leung TW

Department of Surgery, Prince of Wales Hospital, The Chinese University of
Hong Kong, HKSAR, China.

Lo CM

Department of Surgery, The University of Hong Kong, Queen Mary
Hospital, 102 Pokfulam Road, Hong Kong, China. chungmlo@hkucc.hku.hk

Ng, Kelvin K

Department of Surgery, Centre for the Study of Liver Disease, The
University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong
Kong, China.

Pang R

Department of Medicine, Centre for Cancer Research, The University of
Hong Kong, Pokfulam, Hong Kong, China.

Poon RT

Centre for the Study of Liver Disease and Department of Surgery, University
of Hong Kong, Pokfulam, Hong Kong, China. poontp@hkucc.hku.hk

Poon, Ronnie T

Department of Surgery, Centre for the Study of Liver Disease, The
University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong
Kong, China.

To KK

School of Pharmacy, Chinese University of Hong Kong, Shatin, New
Territories, Hong Kong SAR.

Wong J

Centre for the Study of Liver Disease and Department of Surgery, University
of Hong Kong, Pokfulam, Hong Kong, China. poontp@hkucc.hku.hk

Yeo W

Department of Clinical Oncology, Chinese University of Hong Kong, Prince
of Wales Hospital, Shatin, Hong Kong SAR, China.

India

Name of Author

Institutional Affiliation

Bandopadhyaya
GP

Department of Nuclear Medicine, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi, India.

Kumar A

Department of Nuclear Medicine, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi, India.

www.medifocus.com

(800) 965-3002

Italy

Name of Author

Institutional Affiliation

Andriulli A

Department of Gastroenterology, Casa Sollievo della Sofferenza Hospital,
IRCCS, San Giovanni Rotondo, Italy. a.andriulli@operapadrepio.it

DeMatteo RP

Department of Surgery, San Giovanni Hospital, Rome, Italy.

Giulini SM

Department of Medical and Surgical Sciences, University of Brescia,
Brescia, Italy.

Llovet JM

Department of Surgery, Biomedical Statistics, Pathology, National Cancer
Institute of Milan and Chair of Gastroenterology, Policlinico Foundation,
Department of Medicine, University of Milan, Italy.
vincenzo.mazzaferro@istitutotumori.mi.it

Mazzaferro V

Department of Surgery, Biomedical Statistics, Pathology, National Cancer
Institute of Milan and Chair of Gastroenterology, Policlinico Foundation,
Department of Medicine, University of Milan, Italy.
vincenzo.mazzaferro@istitutotumori.mi.it

Perri F

Department of Gastroenterology, Casa Sollievo della Sofferenza Hospital,
IRCCS, San Giovanni Rotondo, Italy. a.andriulli@operapadrepio.it

Portolani N

Department of Medical and Surgical Sciences, University of Brescia,
Brescia, Italy.

Stipa F

Department of Surgery, San Giovanni Hospital, Rome, Italy.

Japan

Name of Author

Institutional Affiliation

Akuta, Norio

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
akuta-gi@umin.ac.jp

Arii S

Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and
Dental University, Graduate School of Medicine, Tokyo, Japan.
shinji.msrg@tmd.ac.jp

Asahara T

Department of Surgery, Division of Frontier Medical Science, Programs for
Biomedical Research, Graduate School of Biomedical Science, Hiroshima
University, Hiroshima, Japan. titamoto@hiroshima-u.ac.jp

Ebara M

Department of Medicine and Clinical Oncology, Graduate School of
Medicine, Chiba University, 1-8-1 Inohana, Chiba-shi, Chiba 260-8670,
Japan. ebara@faculty.chiba-u.jp

Eguchi K

First Department of Internal Medicine, Nagasaki University School of
Medicine, Sakamoto, Nagasaki, Japan. ntaura-gi@umin.ac.jp

Furuse J

Division of Hepatobiliary and Pancreatic Medical Oncology, National
Cancer Center Hospital East, Chiba, Japan. jfuruse@east.ncc.go.jp

Hasegawa K

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery,
University of Tokyo, Japan.

www.medifocus.com

(800) 965-3002

Hatakeyama K

Division of Digestive and General Surgery, Niigata University Graduate
School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata
951-8510, Japan.

Ikeda K

Department of Gastroenterology, Toranomon Hospital, Toranomon 2-2-2,
Minato-ku, Tokyo 105-8470, Japan. ikedakenji@tora.email.ne.jp

Imamura M

Department of Surgery, Otsu Municipal Hospital, Shiga, Japan.
kaido3@hotmail.com

Imaoka S

Department of Surgery, Osaka Medical Center for Cancer and
Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511,
Japan. sasaki-yo@mc.pref.osaka.jp

Itamoto T

Department of Surgery, Division of Frontier Medical Science, Programs for
Biomedical Research, Graduate School of Biomedical Science, Hiroshima
University, Hiroshima, Japan. titamoto@hiroshima-u.ac.jp

Kaibori M

Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1
Shinmachi, Hirakata, Osaka 573-1191, Japan. kaibori@hirakata.kmu.ac.jp

Kaido T

Department of Surgery, Otsu Municipal Hospital, Shiga, Japan.
kaido3@hotmail.com

Kamiyama Y

Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1
Shinmachi, Hirakata, Osaka 573-1191, Japan. kaibori@hirakata.kmu.ac.jp

Kobayashi A

First Department of Surgery, Shinshu University School of Medicine,
Matsumoto, Japan.

Kosuge T

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center
Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. kshimada@ncc.go.jp

Kudo M

Department of Gastroenterology and Hepatology, Kinki University School of
Medicine, Osaka, Japan. m-kudo@med.kindai.ac.jp

Kumada H

Department of Gastroenterology, Toranomon Hospital, Toranomon 2-2-2,
Minato-ku, Tokyo 105-8470, Japan. ikedakenji@tora.email.ne.jp

Kumada,
Hiromitsu

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
akuta-gi@umin.ac.jp

Kuriyama S

Kagawa Medical University, Third Department of Internal Medicine, 1750-1
Ikenobe Miki-cho, Kita-gun, Kagawa 761-0793, Japan. tmasaki@kms.ac.jp

Kurokohchi K

Third Department of Internal Medicine, Kagawa University School of
Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.

Kwon, A-Hon

Department of Surgery, Kansai Medical University, Osaka, Japan.
satoi@takii.kmu.ac.jp

Maehara Y

Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan. taketomi@surg2.med.kyushu-u.ac.jp

Makuuchi M

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery,
University of Tokyo, Japan.

Masaki T

Kagawa Medical University, Third Department of Internal Medicine, 1750-1
Ikenobe Miki-cho, Kita-gun, Kagawa 761-0793, Japan. tmasaki@kms.ac.jp

www.medifocus.com

(800) 965-3002

Miyagawa Y

First Department of Surgery, Shinshu University School of Medicine,
Matsumoto, Japan.

Monden M

Department of Surgery and Clinical Oncology, Graduate School of Medicine,
Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka 565-0871, Japan.

Mori M

Department of Medicine and Molecular Science, Gunma University Graduate
School of Medicine, 3-39-15 Showa-machi, Maebashi, 371-8511 Gunma,
Japan.

Nagayasu T

Division of Surgical Oncology, Department of Translational Medical
Sciences, Nagasaki University Graduate School of Biomedical Sciences,
1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

Nakao A

Department of Surgery II, Nagoya University School of Medicine, Nagoya
466-8550, Japan. sakakima@med.nagoya-u.ac.jp

Nakazawa T

Gastroenterology Division of Internal Medicine, Kitasato University East
Hospital, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan.
tnakazaw@kitasato-u.ac.jp

Nanashima A

Division of Surgical Oncology, Department of Translational Medical
Sciences, Nagasaki University Graduate School of Biomedical Sciences,
1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

Obi S

Department of Hepatology, Kyoundo Hospital, Tokyo, Japan.
obi-shun@imail.plala.or.jp

Ohmoto K

Division of Hepatology, Department of Medicine, Kawasaki Medical School,
Okayama, Japan. ohmotok@med.kawasaki-m.ac.jp

Ohtomo K

Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
yamashitah-rad@h.u-tokyo.ac.jp

Omata M

Department of Gastroenterology, Faculty of Medicine, University of Tokyo,
Japan.

Ota H

Department of Surgery and Clinical Oncology, Graduate School of Medicine,
Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka 565-0871, Japan.

Saigenji K

Gastroenterology Division of Internal Medicine, Kitasato University East
Hospital, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan.
tnakazaw@kitasato-u.ac.jp

Saisho H

Department of Medicine and Clinical Oncology, Graduate School of
Medicine, Chiba University, 1-8-1 Inohana, Chiba-shi, Chiba 260-8670,
Japan. ebara@faculty.chiba-u.jp

Sakakima Y

Department of Surgery II, Nagoya University School of Medicine, Nagoya
466-8550, Japan. sakakima@med.nagoya-u.ac.jp

Sasaki Y

Department of Surgery, Osaka Medical Center for Cancer and
Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511,
Japan. sasaki-yo@mc.pref.osaka.jp

Satoi, Sohei

Department of Surgery, Kansai Medical University, Osaka, Japan.
satoi@takii.kmu.ac.jp

www.medifocus.com

(800) 965-3002

Shimada K

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center
Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. kshimada@ncc.go.jp

Takayasu K

Department of Diagnostic Radiology, National Cancer Center Hospital,
Tokyo, Japan. ktakayas@ncc.go.jp

Taketomi A

Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan. taketomi@surg2.med.kyushu-u.ac.jp

Tanaka S

Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and
Dental University, Graduate School of Medicine, Tokyo, Japan.
shinji.msrg@tmd.ac.jp

Taura N

First Department of Internal Medicine, Nagasaki University School of
Medicine, Sakamoto, Nagasaki, Japan. ntaura-gi@umin.ac.jp

Teratani T

Department of Gastroenterology, Faculty of Medicine, University of Tokyo,
Japan.

Tsukioka G

Department of Medicine and Molecular Science, Gunma University Graduate
School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511,
Japan.

Wakai T

Division of Digestive and General Surgery, Niigata University Graduate
School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata
951-8510, Japan.

Yamamoto S

Division of Hepatology, Department of Medicine, Kawasaki Medical School,
Okayama, Japan. ohmotok@med.kawasaki-m.ac.jp

Yamaoka Y

Department of Diagnostic Radiology, National Cancer Center Hospital,
Tokyo, Japan. ktakayas@ncc.go.jp

Yamashita H

Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
yamashitah-rad@h.u-tokyo.ac.jp

Yamazaki Y

Department of Medicine and Molecular Science, Gunma University Graduate
School of Medicine, 3-39-15 Showa-machi, Maebashi, 371-8511 Gunma,
Japan.

Yoshino M

Division of Hepatobiliary and Pancreatic Medical Oncology, National
Cancer Center Hospital East, Chiba, Japan. jfuruse@east.ncc.go.jp

Korea

Name of Author

Institutional Affiliation

Ahn CS

Division of Hepatobiliary Surgery and Liver Transplantation, Department of
Surgery, Asan Medical Centre, University of Ulsan College of Medicine,
Seoul 138-736, Korea. sglee2@amc.seoul.kr

Choo IW

Department of Radiology and Center for Imaging Sciences, Division of
Gastroenterology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.

Huh, Seung Jae

Research Institute and Hospital, National Cancer Center, Gyeonggi, Korea.

Kim CM

Research Institute and Hospital, National Cancer Center, Goyang, Korea.

www.medifocus.com

(800) 965-3002

Kim TH

Research Institute and Hospital, National Cancer Center, Goyang, Korea.

Kim, Dae Yong

Research Institute and Hospital, National Cancer Center, Gyeonggi, Korea.

Lee SG

Division of Hepatobiliary Surgery and Liver Transplantation, Department of
Surgery, Asan Medical Centre, University of Ulsan College of Medicine,
Seoul 138-736, Korea. sglee2@amc.seoul.kr

Shin SW

Department of Radiology and Center for Imaging Sciences, Division of
Gastroenterology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.

Mexico

Name of Author

Institutional Affiliation

Mendez-Sanchez
N

Department of Biomedical Research and Liver Unit, Medica Sur Clinic &
Foundation, Mexico City, Mexico.

Motola-Kuba D

Department of Biomedical Research and Liver Unit, Medica Sur Clinic &
Foundation, Mexico City, Mexico.

Poland

Name of Author

Institutional Affiliation

Czauderna P

Department of Pediatric Surgery, Medical University of Gdansk, Gdansk,
Poland. pczaud@amg.gda.pl

Stoba C

Department of Pediatric Surgery, Medical University of Gdansk, Gdansk,
Poland. pczaud@amg.gda.pl

Singapore

Name of Author

Institutional Affiliation

Hean TK

Department of General Surgery, Changi General Hospital, 2 Simei Street 3,
Changi, Singapore 507027. salleh_ibrahim@cgh.com.sg

Ibrahim S

Department of General Surgery, Changi General Hospital, 2 Simei Street 3,
Changi, Singapore 507027. salleh_ibrahim@cgh.com.sg

South Korea

Name of Author

Institutional Affiliation

Jang JW

Department of Internal Medicine, College of Medicine, WHO Collaborating
Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.

Kim BW

Department of Surgery, Ajou University School of Medicine, San-5 442-749,
Wonchon dong, Youngtong ku, Kyounggi Province, Suwon, South Korea.

www.medifocus.com

(800) 965-3002

Kim JK

Department of Internal Medicine, Yonsei Institute of Gastroenterology,
Yonsei Liver Cancer Study Group, Yonsei University College of Medicine,
134 Shinchoin-dong, Seodaemoon-gu, Seoul, Korea 120-752.

Kim JS

Division of Hematology/Oncology Department of Internal Medicine, Korea
University Medical Center, 126-1, Anam-dong 5-ga, Sungbuk-ku, Seoul,
136-705, Korea.

Kim MW

Department of Surgery, Ajou University School of Medicine, San-5 442-749,
Wonchon dong, Youngtong ku, Kyounggi Province, Suwon, South Korea.

Kim SJ

Division of Hematology/Oncology Department of Internal Medicine, Korea
University Medical Center, 126-1, Anam-dong 5-ga, Sungbuk-ku, Seoul,
136-705, Korea.

Kim WK

Department of Surgery, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, Seoul , 110-744, Korea.

Lee YS

Department of Internal Medicine, College of Medicine, WHO Collaborating
Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.

Moon YM

Department of Internal Medicine, Yonsei Institute of Gastroenterology,
Yonsei Liver Cancer Study Group, Yonsei University College of Medicine,
134 Shinchoin-dong, Seodaemoon-gu, Seoul, Korea 120-752.

Yu SB

Department of Surgery, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, Seoul , 110-744, Korea.

Spain

Name of Author

Institutional Affiliation

Avila MA

Division of Hepatology and Gene Therapy, Center for Applied Medical
Research (CIMA), University of Navarra, Pamplona, Spain.

Bernal E

Liver Transplant Unit, Reina Sofia University Hospital, Cordoba, Spain.

Bruix J

BCLC Group. Liver Unit. Hospital Clinic, University of Barcelona, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.
bruix@ub.edu

Gomez Senent S

Department of Gastroenterology, La Paz University Hospital, Madrid, Spain.
silviagsenent@yahoo.es

Gonzalez Baron
M

Department of Gastroenterology, La Paz University Hospital, Madrid, Spain.
silviagsenent@yahoo.es

Guan M

Division of Hepatology and Gene Therapy, School of Medicine, Centro de
Investigacion Medica Aplicada, University of Navarra, 31008 Pamplona,
Spain.

Hernandez-Alcoce
ba R

Division of Gene Therapy and Hepatology, Edificio CIMA, Av. Pio XII, 55,
Pamplona 31008, Spain.

Llovet JM

BCLC Group, Liver Unit, IDIBAPS, Digestive Disease Institute, Hospital
Clinic, University of Barcelona, Catalonia, Spain. bruix@ub.edu

www.medifocus.com

(800) 965-3002

100

Prieto J

Liver Unit, Department of Internal Medicine, Clinica Universitaria de
Navarra, Pamplona, Spain. bsangro@unav.es

Qian C

Division of Hepatology and Gene Therapy, School of Medicine, Centro de
Investigacion Medica Aplicada, University of Navarra, 31008 Pamplona,
Spain.

Sangro B

Liver Unit, Department of Internal Medicine, Clinica Universitaria de
Navarra, Pamplona, Spain. bsangro@unav.es

Sherman M

BCLC Group. Liver Unit. Hospital Clinic, University of Barcelona, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.
bruix@ub.edu

de la Mata M

Liver Transplant Unit, Reina Sofia University Hospital, Cordoba, Spain.

Taiwan

Name of Author

Institutional Affiliation

Chen CH

Department of Internal Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, Taipei, Taiwan.

Chen PM

Division of Medical Oncology, Department of Medicine, Taipei Veterans
General Hospital, and the National Yang-Ming University Taipei, Taiwan.

Chen, Ding-Shinn

Department of Internal Medicine, National Taiwan University Hospital,
Taipei, Taiwan.

Chen, Y-C

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung
University, 199 Tung Hwa North Rd, Taipei, Taiwan.
lsmpaicyto@cgmh.org.tw

Hsu HC

Department of Radiation Oncology, Chang Gung Memorial
Hospital-Kaohsung Medical Center, 123, Ta-Pei Road, Niao Sung Hsian,
Kaohsiung 807, Taiwan. hsuan5@ms65.hinet.net

Hsu WC

Department of Radiation Oncology, Cheng-Ching General Hospital,
Taichung, Taiwan.

Huang YH

Division of Gastroenterology, Department of Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan.

Huang,
Guan-Tarn

Department of Internal Medicine, National Taiwan University Hospital,
Taipei, Taiwan.

Lee SD

Division of Gastroenterology, Department of Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan.

Lin GD

Department of Radiation Oncology, Cheng-Ching General Hospital,
Taichung, Taiwan.

Lin, S-M

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung
University, 199 Tung Hwa North Rd, Taipei, Taiwan.
lsmpaicyto@cgmh.org.tw

www.medifocus.com

(800) 965-3002

101

Liu TW

Division of Cancer Research, National Health Research Institutes, Ward 191
Veterans General Hospital, Taipei, and Department of Internal Medicine,
Kaohsiung Medical University Hospital, Taiwan, ROC.

Lu SN

Department of Internal Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, Taipei, Taiwan.

Poh SB

Division of Medical Oncology, Department of Medicine, Taipei Veterans
General Hospital, and the National Yang-Ming University Taipei, Taiwan.

Shiah HS

Division of Cancer Research, National Health Research Institutes, Ward 191
Veterans General Hospital, Taipei, and Department of Internal Medicine,
Kaohsiung Medical University Hospital, Taiwan, ROC.

Wang CY

Department of Radiation Oncology, Chang Gung Memorial
Hospital-Kaohsung Medical Center, 123, Ta-Pei Road, Niao Sung Hsian,
Kaohsiung 807, Taiwan. hsuan5@ms65.hinet.net

United Kingdom

Name of Author

Institutional Affiliation

Burroughs AK

Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital,
Pond Street, NW3 2QG London, UK. marellilaura@tiscali.it

Heaton N

Institute of Liver Studies, King's College Hospital, Denmark Hill, London
SE5 9RS, UK.

Marelli L

Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital,
Pond Street, NW3 2QG London, UK. marellilaura@tiscali.it

Sutcliffe R

Institute of Liver Studies, King's College Hospital, Denmark Hill, London
SE5 9RS, UK.

www.medifocus.com

(800) 965-3002

102

5 - Tips on Finding and Choosing a Doctor

Introduction

One of the most important decisions confronting patients who have been diagnosed with a serious medical
condition is finding and choosing a qualified physician who will deliver a high level and quality of medical
care in accordance with currently accepted guidelines and standards of care. Finding the "best" doctor to
manage your condition, however, can be a frustrating and time-consuming experience unless you know
what you are looking for and how to go about finding it.

The process of finding and choosing a physician to manage your specific illness or condition is, in some
respects, analogous to the process of making a decision about whether or not to invest in a particular stock
or mutual fund. After all, you wouldn't invest your hard eared money in a stock or mutual fund without first
doing exhaustive research about the stock or fund's past performance, current financial status, and projected
future earnings. More than likely you would spend a considerable amount of time and energy doing your
own research and consulting with your stock broker before making an informed decision about investing.
The same general principle applies to the process of finding and choosing a physician. Although the process
requires a considerable investment in terms of both time and energy, the potential payoff can be well worth
it--after all, what can be more important than your health and well-being?

This section of your Guidebook offers important tips for how to find physicians as well as suggestions for
how to make informed choices about choosing a doctor who is right for you.

Tips for Finding Physicians

Finding a highly qualified, competent, and compassionate physician to manage your specific illness or
condition takes a lot of hard work and energy but is an investment that is well-worth the effort. It is
important to keep in mind that you are not looking for just any general physician but rather for a physician
who has expertise in the treatment and management of your specific illness or condition. Here are some
suggestions for where you can turn to identify and locate physicians who specialize in managing your
disorder:

• Your Doctor - Your family physician (family medicine or internal medicine specialist) is a good

starting point for finding a physician who specializes in your illness. Chances are that your doctor
already knows several specialists in your geographic area who specialize in your illness and can
recommend several names to you. Your doctor can also provide you with information about their
qualifications, training, and hospital affiliations.

• Your Peer Network - Your family, friends, and co-workers can be a potentially very useful network

for helping you find a physician who specializes in your illness. They may know someone else with
this condition and may be able to put you in touch with them to find out which doctors they can
recommend. If you have friends, neighbors, or relatives who work in hospitals (e.g., nurses, social
workers, administrators), they may be a potentially valuable source for helping you find a physician
who specializes in your condition.

• Hospitals and Medical Centers - Hospitals and medical centers are, potentially, an excellent source

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for finding physicians who specialize in treating specific diseases. Simply contact hospitals and major
medical centers in your city, county, or state and ask if they have anyone on their staff who specializes
in treating your condition. When you call, ask to speak to someone in the specific Department that
cares for patients with the illness. For example, if you have been diagnosed with cancer, ask to speak
with someone in the Department of Hematology and Oncology. If you are not sure which Department
treats patients with your specific condition, ask to speak to someone in the Department of Medicine
since this Department is the umbrella for many other medical specialties.

• Organizations and Support Groups - Many disease organizations and support groups that cater to patients

with a specific illness or condition maintain physician referral lists and may be able to recommend doctors
in your geographic area who specialize in the treatment and management of your specific disorder. This
MediFocus Guidebook includes a select listing of disease organizations and support groups that you may
wish to contact to ask for a physician referral.

• Managed Care Plans - If you belong to a managed care plan, you can obtain a list of physicians who

belong to the Plan from the plan's membership services office. Keep in mind, however, that your choices
will usually be limited to only those doctors who belong to the Plan. If you decide to go outside the Plan,
you will likely have to pay for the doctor's services "out of pocket".

• Medical Journals - Many doctors based at major medical centers and universities who have special interest

in a particular disease or condition conduct research and publish their findings in leading medical journals.
Searching the medical literature can help you identify and locate leading physicians who are recognized as
experts in their field about a particular illness. This MediFocus Guidebook includes an extensive listing of
the names and institutional affiliations of physicians and researchers, in the United States and other
countries, who have recently published their studies about this specific medical condition in leading medical
journals. You can also conduct your own online search for your illness or condition and identify additional
authors and hospitals who specialize in the disease using the PubMed database available at

http://www.nlm.nih.gov

• American Medical Association - The American Medical Association (AMA) is the nation's largest

professional medical association that represents many doctors in the United States and also provides a free
physician locator service called "AMA Physician Select" available at

http://dbapps.ama-assn.org/aps/amahg.htm

. You can search the AMA database by either "Physician Name"

or "Medical Specialty". You can find information about physicians including medical school and residency
training, area of specialty, and contact information.

• American Board of Medical Specialists - The American Board of Medical Specialists (ABMS) publishes

a geographical list of board-certified physicians called the Official ABMS Directory of Board Certified
Medical Specialists that is available in most public libraries. Physicians who are listed in the ABMS
Directory are board-certified in a medical specialty meaning that they have passed rigorous certification
examinations administered by a board of medical specialists. There are 24 specialty boards that are
recognized by the ABMS and the AMA. Each candidate applying for board certification must pass a written
examination given by the specific specialty board and 15 of the specialty boards also require candidates to
pass an oral examination in order to obtain board certification. To find out if a particular physician you are
considering is board certified:

• Visit your local public library and ask for a copy of the Official ABMS Directory of Board Certified

Medical Specialists.

• Search the ABMS web site at

http://www.abms.org/login.asp

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• Call the ABMS toll free at 1-866-275-2267.

• American Society of Clinical Oncology - The American Society of Clinical Onclology (ASC)) is the largest

professional organization that represents physicians who specialize in treating cancer patients (oncologists). The
ASCO provides a searchable database of ASCO members called "Find an Oncologist" that you can access online
at

http://www.asco.org

. You can search the "Find an Oncologist" database for a cancer specialist by name, city,

state, country, or specialty area.

• American Cancer Society - The American Cancer Society (ACS) is a nationwide voluntary health organization

dedicated to helping cancer patients and survivors through research, education, advocacy, and services. The ACS
web site

http://www.cancer.org

is not only an excellent resource for cancer information but also includes a

"Message Board" where you can ask questions, exchange ideas, and share stories. The ACS Message Board is
also a potentially useful source for locating an oncologist in your geographical area who specializes in your
specific type of cancer. You can also contact the ACS toll free by calling 1-800-ACS-2345.

• National Comprehensive Cancer Network - The National Comprehensive Cancer Network (NCCN) is an

alliance of 19 of the world's leading cancer centers and is dedicated to helping patients and health care
professionals make informed decisions about cancer care. You can find a listing of the 19 NCCN member cancer
institutions on the NCCN web site at

http://www.nccn.org/

. You can also search the NCCN "Physician Directory"

for doctors located at any of the 19 NCCN member cancer institutions at

http://www.nccn.org/physician_directory/SearchPers.asp

. This database is an excellent resource for locating

leading cancer specialists nationwide who specialize in your specific type of cancer.

• National Cancer Institute Clinical Trials Database - The National Cancer Institute (NCI) is part of the National

Institutes of Health (NIH) and coordinates the National Cancer Program which conducts and supports research,
training, and a variety of other programs dedicated to prevention and treatment of cancer. The NCI maintains an
extensive cancer clinical trials database that you can access at

http://www.cancer.gov/clinicaltrials

. You can

search the database for current clinical trials by type of cancer and even limit your search to clinical trials within
you geographical area by putting in your Zip Code. The NCI clinical trials database also provides contact
information for the physicians who serve as the study coordinators for each clinical trial. This database is a
valuable resource for identifying and locating leading physicians in your local area and around the country who
are conducting cutting-edge clinical research about your specific type of cancer.

• National Center for Complementary and Alternative Medicine - The National Center for Complementary and

Alternative Medicine (NCCAM) is part of the National Institutes of Health (NIH) and is dedicated to exploring
complementary and alternative medicine healing practices in the context of rigorous scientific research and
methodology. The NCCAM web site

http://nccam.nih.gov/

includes publications, frequently asked questions, and

useful links to other complementary and alternative medicine resources. If you have questions about
complementary and alternative medicine practices for your particular illness or medical condition, you can contact
the NCCAM Clearinghouse toll-free in the U.S. at 1-888-644-6226 or 301-519-3153. You can also contact the
NCCAM Clearinghouse by E-mail: info@nccam.nih.gov.

• National Organization for Rare Disorders - The National Organization for Rare Disorders (NORD) is a

federation of voluntary health organizations dedicated to helping patients with rare "orphan" diseases and their
families. There are over 6,000 rare or "orphan" diseases that are estimated to affect approximately 25 million
Americans. You can search NORD's "Rare Diseases Database" for information about rare diseases at

http://www.rarediseases.org/search/rdblist.html

. In addition to providing useful information about rare diseases,

NORD maintains a confidential "Networking Program" for its members to enable them to communicate with

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other patients who suffer from the same disorder. To learn more about NORD's Networking Program, you can
send an E mail to: orphan@rarediseases.org.

How to Make Informed Choices About Physicians

It has generally been assumed by many people that the longer a physician has been in practice, the more
experience, knowledge, and skills he/she has accumulated and, therefore, the higher the quality of care they
provide to their patients. Recent research conducted by a group of doctors from the Harvard Medical School,
however, seems to strongly suggest that this premise may not be true. In an article published in February 2005 in
the Annals of Internal Medicine (Volume 142, No. 4, pp. 260-303), the Harvard researchers seriously challenged
the common assumption that the more clinical experience a physician has accumulated, the higher the level of
medical care they provide to their patients.

In fact, surprisingly, the researchers found an inverse (opposite) relationship between the number of years that a
physician has been in practice (i.e., experience) and the quality of care that the physician provides. In other words,
the widely held belief that "practice makes perfect" does not necessarily apply to all physicians and should not be
the sole criteria used by patients in their decision analysis for choosing a physician. The underlying message of
this study is that the length of time a physician has been in practice does not necessarily equate to a high quality
of medical care unless the doctor takes steps to keep abreast with new advances and changing patterns of clinical
practice.

Here are some important issues you need to consider and carefully research before making an informed decision
about choosing your doctor:

• Board Certification - Board certified doctors are required to have extra training after medical school to

become specialists in a particular field of medicine and are required to take continuing education courses in
order to maintain their board certification status. Check with the American Board of Medical Specialists
(ABMS) to determine if a specific physician you are considering is board certified in a particular medical
specialty. To find out if a particular physician you are considering is board certified:

• Visit your local public library and ask for a copy of the Official ABMS Directory of Board Certified

Medical Specialists.

• Search the ABMS web site at

http://www.abms.org/login.asp

• Call the ABMS toll free at 1-866-275-2267.

• Experience - As noted above, research from the Harvard Medical School strongly suggests that how long a

physician has been in practice (i.e., experience) does not necessarily correlate with a high level of medical
care. The most important issue, therefore, is not how long a doctor has been in practice but rather how much
experience the physician has in treating your specific illness or medical condition. Some physicians who
have been in practice for many decades may have only treated a small number of patients with the specific
disorder, whereas, some younger physicians who have been in practice only a few years may have already
treated hundreds of patients with the same disorder. Here are some suggestions for helping you find out
about a particular physician's experience in treating your specific illness:

• Call the physician's office and speak with a staff member such as a nurse or physician's assistant. Ask

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them for information about how many patients with your specific medical condition the physician
treats during the course of a year. Ask how many patients with this condition the physician is
currently treating. You will have to call several different physicians' offices in order to have a basis
for comparing the numbers of patients.

• Find out if the physician has published any articles about the condition in reputable medical journals by

doing an author search online. You can conduct an online author search using PubMed at

http://www.nlm.nih.gov

. Simply click on the "PubMed" icon, select the "author" field from the "Limits"

menu, enter the physician's name (last name followed by first initial), and then click on the "Go" button.
The author search will retrieve all articles published by the particular physician you are considering.

• Talk with your family physician and ask if he/she can provide you with any information about the particular

physician's experience in treating patients with your specific illness or condition.

• Contact disease organizations and support groups that specialize in helping patients with your specific

disorder and ask if they can provide you with any information, including experience, about the physician
you are considering.

• Medical School Affiliation - Find out if the physician you are considering also has a joint faculty appointment at

a medical school. In general, practicing community physicians with a joint academic appointment at a medical
school are more likely to be in contact with leading medical experts and may be more up-to-date with the latest
advances in research and treatments than community based physicians who are not affiliated with a medical
school.

• Hospital Affiliation - Find out about the hospitals that the doctor uses. In the event that you need to be treated at

a hospital, is the hospital where the physician has admitting privileges nearby to your home or will you (and your
family members) have to travel a considerable distance?

• Hospital Accreditation - Find out if the hospital where the physician has admitting privileges is accredited by the

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). You can find information about a
specific hospital's accreditation status by searching the JCAHO web site at

http://www.jointcommission.org/

. The

JCAHO is an independent, not-for-profit organization that evaluates and accredits more than 15,000 health care
organizations and programs in the United States. To receive and maintain JCAHO accreditation, a health care
organization must undergo an on-site survey by a JCAHO survey team at least every three years and meet specific
standards and performance measurements that affect the safety and quality of patient care.

• Health Insurance Coverage - Find out if the physician is covered by your health insurance plan. If you belong to

a managed care plan (HMO or PPO), you are usually restricted to using specific physicians who also belong to the
Plan. If you decide to use a physician who is "outside the network," you will likely have to pay "out of pocket" for
the services provided.

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6 - Directory of Organizations

Abramson Cancer Center - University of Pennsylivania

3400 Spruce Street; 2 Donner; Philadelphia, PA 19104-4283
215.349.5445 (f)

www.oncolink.upenn.edu

Adrienne Wilson Liver Cancer Association

1135 N. Valley Street; Burbank, CA 91505
818.636.5624

www.bluefaery.org

American Cancer Society

1599 Clifton Road NE; Atlanta, GA 30329-4251
404.486.0100, 800.227.2345; 404.228.4327 (fax)

www.cancer.org

American College of Gastroenterology

POB 342260; Bethesda, MD 20827
301.263.9000

www.acg.gi.org

American Institute for Cancer Research; Nutrition Hotline

1759 R St., NW.; Washington, DC 20009
202.328.7744 800.843.8114; 202.328.7226 (Fax)

aicrweb@aicr.org
www.aicr.org

Association of Cancer Online Resources

www.acor.org

Cancer Bacup; Helping People Live With Cancer

3 Bath Place; Rivington Street; London, EC2A 3JR UNITED KINGDOM
44.0.20.7696.9003 0808.800.1234

www.cancerbacup.org.uk

Cancer Care

275 7th Avenue; New York, NY 10001
800.813.4673

www.cancercare.org

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Cancer Caring Center

4117 Liberty Avenue; Pittsburgh, PA 15224
412.622.1212 412.622.1216 (fax)

cancercr@stargate.net
www.cancercaring.org

Cancer Hope Network

2 North Road; Chester, NJ 07930
877.467.3635

info@cancerhopenetwork.org
www.cancerhopenetwork.org

Cancer Information Network

www.ontumor.com

Cancer Information Service

6116 Executive Boulevard; Room 3036A; Bethesda, MD 20892
800.422.6237 800.332.8615 (TTY)

www.cancer.gov

Candlelighters Childhood Cancer Foundation

POB 498; Kensington, MD 20895
800.366.2223 301.962.3520; 301.962.3521 (fax)

staff@candlelighters.org
www.candlelighters.org

Cleveland Clinic Taussig Cancer Center

9500 Euclid Avenue; Cleveland, OH 44195
800.862.7798

www.clevelandclinic.org/cancer

Dana-Farber Cancer Institute

44 Binney Street; Boston, MA 02115
866.408.3324 617.632.5330 (TDD)

dana-farbercontactus@dfci.harvard.edu
www.dana-farber.net

Digestive Disorders Foundation

CORE; 3 St. Andrews Place; London, NW1 4LB UNITED KINGDOM
020 7486 0341

info@corecharity.org.uk
www.digestivedisorders.org.uk

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Ellis Fischel Cancer Center; University of Missouri Health Sciences Center

115 Business Loop 70 West; Columbia, MO 65203
573.882.2100

muhealth@health.missouri.edu
www.ellisfischel.org

European Organization for Research and Treatment of Cancer

Avenue E Mounier 83, boite 11; B-1200, Brussels; BELGIUM
+32 2-774-1611

www.eortc.be

Fox Chase Cancer Center

333 Cottman Avenue; Philadelphia, PA 19111
888.369.2427 215.728.6900

www.fccc.edu

Fred Hutchinson Cancer Research Center

1100 Fairview Avenue North; PO Box 19024; Seattle, WA 98109
800.804.8824 206.288.1024; 206.288.1025 (fax)

hutchdoc@fhcrc.org
www.fhcrc.org

Georgetown University; Lombardi Cancer Research Center

3800 Reservoir Rd. NW; Washington, DC 20057
202.444.4000

lombardi.georgetown.edu

Liver Cancer Network; Alleghany General Liver Cancer Program

320 East North Avenue; Pittsburgh, PA 15212-4772
412.359.6738; 412.359.6288 (f)

www.livercancer.com

Liver Tumor.Org

info@livertumor.org
www.livertumor.org

Look Good...Feel Better; American Cancer Society

1599 Clifton Road, NE; Atlanta, GA 30329
800.395.5665

www.lookgoodfeelbetter.org

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M.D. Anderson Cancer Center

1515 Holcombe Blvd.; Houston, TX 77030
713.792.6161; 800.392.1611

www.mdanderson.org

Mayo Clinic Cancer Center

200 First Street SW; Rochester, MN 55905
507.284.2511

www.mayoclinic.org

McGill University Cancer Centre

McIntyre Medical Sciences Building; 3655 Promenade Sir William Osler; Montreal, Quebec; H3G 1Y6
CANADA
514.398.3535 514.398.6769 (f)

www.med.mcgill.ca/cancer

Memorial Sloan-Kettering Cancer Center

1275 York Avenue; New York, NY 10021
800.525.2225 212.639.2000

www.mskcc.org

New York Presbyterian Hospital; Comprehensive Cancer Center

622 West 168th Street; New York, NY 10032
212.305.2500; 212.305.6889 fax

www.nyp.org

People Living with Cancer; American Society of Clinical Oncology

1900 Duke Street; Suite 200; Alexandria, VA 22314
703.797.1914 703.299.1044 (fax)

contactus@plwc.org
www.plwc.org

R. A. Bloch Cancer Foundation

4400 Main Street; Kansas City, MO 64111
816.932.8453 800.433.0464; 816.931.7486 (f)

www.blochcancer.org

Robert H. Lurie Cancer Center; Northwestern University

Galter Pavillion; 675 N. St. Clair 21st Floor; Chicago, IL 60611
866.587.4322 312.908.5250; 312.908.1372 (FAX)

cancer@northwestern.edu
www.lurie.northwestern.edu

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Sylvester Comprehensive Cancer Center

1475 NW 12th Street Stree; Miami, FL 33136
800.545.2292 305.243.1000

www.sylvester.org

The Wellness Community

919 18th Street NW; Washington, DC 20006
800.793.9355 202.659.9709; 202.659.9301 (fax)

help@thewellnesscommunity.org
www.thewellnesscommunity.org

University of Chicago Hospitals; Cancer Research Center

5841 South Maryland Avenue; Chicago, IL 60637
877.824.0660 773.702.1000; 773.702.2517 (fax)

healthlink@uchospitals.edu
www.uchospitals.edu/specialties/cancer

University of Wisconsin Comprehensive Cancer Center

600 Highland Avenue K5/601; Madison, WI 53792-6164
608.263.8600 800.622.8922; 608.263.8613 (f)

uwccc@uwccc.wisc.edu
www.cancer.wisc.edu

USC/Norris Comprehensive Cancer Center; University of Southern California

1441 Eastlake Avenue; Los Angeles, CA 90033
323.865.3000

ccnt.hsc.usc.edu

Women's Cancer Resource Center

5741 Telegraph Avenue; Oakland, CA 94609
888.421.7900 510.420.7900; 510.601.4045 (fax)

wcrc@wcrc.org
www.wcrc.org

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Complementary and Alternative Medicine Resources

American Academy of Medical Acupuncture

4929 Wilshire Boulevard
Suite 428
Los Angeles, CA 90010
Phone: 323.937.5514

jdowden@prodigy.net

http://www.medicalacupuncture.org

American Association for Acupuncture and Oriental Medicine

1925 West County Road B2
Roseville, MN 55113
Phone: 651.631.0204

http://www.aaaom.edu

American Association of Ayurvedic Medicine

College Medical Associates
1603 North Four Building 144
Fairfield, IA 52556
Phone: 515.472.8477

cma@mum.edu

American Association of Naturopathic Physicians

4435 Wisconsin Avenue
Suite 403 Washington, DC 20016
Phone (Toll free): 866.538.2267
Phone: 202.237.8150

http://www.naturopathic.org

American Chiropractic Association

1701 Clarendon Blvd.
Arlington, VA 22209
Phone: 703.276.8800

memberinfo@acatoday.org

http://www.amerchiro.org

American Holistic Medical Association

P.O. Box 2016
Edmonds, WA 98020 Phone: 425.967.0737

http://www.holisticmedicine.org

American Massage Therapy Association

500 Davis Street, Suite 900
Evanston, IL 60201-4695
Phone (Toll-Free): 877.905.2700
Phone: 847.864.0123

info@amtamassage.org

http://www.amtamassage.org

National Association for Chiropractic Medicine

1527 Baybrook Drive
Houston, TX 77062

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281.280.8262

http://www.chiromed.org

National Center for Complementary and Alternative Medicine (NCCAM)
Clearinghouse

9000 Rockville Pike Bethesda, MD 20892 Phone: 888.644.6226

info@nccam.nih.gov

http://nccam.nih.gov

National Center for Homeopathy

801 North Fairfax Street, Suite 306
Alexandria, VA 22314
Phone: 703.548.7790

http://www.homeopathic.org

Office of Dietary Supplements, National Institutes of Health

6100 Executive Boulevard
Room 3B01, MSC 7517
Bethesda, MD 20892-7517
Phone: 301.435.2920

http://dietary-supplements.info.nih.gov

Rosenthal Center for Complementary and Alternative Medicine

Columbia Presbyterian Hospital
630 West 168th Street
Box 75
New York, NY 10032
Phone: 212.342.0101

http://rosenthal.hs.columbia.edu

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Document Outline

How To Use This Medifocus Guidebook
Table of Contents
1 - Background Information
2 - The Intelligent Patient Overview
3 - Guide to the Medical Literature
- Introduction
- Recent Literature: What Your Doctor Reads
4 - Centers of Research
- United States
- Other Countries
  - Australia
  - Canada
  - China
  - France
  - Germany
  - Hong Kong
  - India
  - Italy
  - Japan
  - Korea
  - Mexico
  - Poland
  - Singapore
  - South Korea
  - Spain
  - Taiwan
  - United Kingdom
5 - Tips on Finding and Choosing a Doctor
6 - Directory of Organizations

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