Clinical Dilemmas in Liver Cancer follows the successful format of the other books in the Clinical Dilemmas series, with each chapter focused on a specific dilemma, or issue facing doctors in their day-to-day job, and providing them with practical clinical information and help to better assessment and treat their patients in this case patients suffering from liver cancer, the third commonest cancer in terms of mortality worldwide.

Chapters feature up-to-date information on the basic mechanisms, epidemiological risk factors, screening and surveillance strategies, diagnosis and treatment. It is an extremely practical and clinically-orientated book, and as most patients around the world present with advanced disease, a main focus is on the most recent advances allowing early diagnosis and use of locoregional and systemic therapy, surgery, transplantation and combination therapies. Each chapter is authored by an international expert in the relevant area.

Professor Roger Williams CBE, runs the Institute of Hepatology at UCL, and is a twice former president of EASL. He has authored an incredible 2100 journal articles. Despite advancing years, he is still actively involved in clinical research340 articles in the past ten years, and analysis by ISI shows him to be one of the most influential researchers in his field. The award of a CBE for services to medicine recognised his major contribution to the study of liver disorders over 25 years including leading the team who performed the first ever liver transplant in the UK. Prof Williams has had many awards, medals, honorary fellowships, and in 2006 was included by HRH The Queen in a celebration at Buckingham Palace to honour those who continue to contribute to public service beyond the age of 65yrs. He was made a Fellow of King's College London in 1992 and an Honorary Fellowship from UCL was conferred on him in 2008, in recognition of his distinguished career and outstanding service to UCL.

Professor Simon Taylor-Robinson joined the Department of Medicine at Imperial College London in 1997, having previously been Senior Registrar in Gastroenterology and Hepatology at Hammersmith Hospital. He was awarded the Sir Francis Avery Jones Gold Medal by the British Society of Gastroenterology in 1999 and the Young Investigator Award of the Liver Section of the European Gastroenterology Association in 1997. He is currently Director of the Imperial Clinical Research Facility at St Mary's Hospital, London.

List of Contributors, vii

Preface, x

Part 1: Learning from a Worldwide Perspective

1 Are patterns and prevalence changing?, 3
Hashem B. El-Serag

2 Why is the tumour different in Africa?, 11
Nimzing G. Ladep

3 Control by vaccination: Asian and Taiwan experience, 18
Jia-Horng Kao

4 The view from the United Kingdom, 24
Shahid A. Khan, Mireille B. Toledano, Abigail Zabron, Mehtan Ahmed, and Simon D. Taylor-Robinson

5 The view from the United States, 29
Hitoshi Maruyama and Arun J. Sanyal

6 New challenges of the NAFLD and HIV epidemics, 35
Quentin M. Anstee and Janice Main

Part 2: Influence of Tumour Characteristics

7 Controversies in pathology, 45
Tania Roskams

8 Not to forget the unusual tumour, 53
Bernard C. Portmann

9 What can be learned from molecular diagnostic techniques and genetic signatures?, 60
Tariq Moatter and Saeed Hamid

Part 3: Complexities of Patient Assessment and Scoring Systems

10 Looking after the liver as well as the tumour, 67
Roger Williams

11 Comparative performances of staging systems for hepatocellular cancer: early HCC considerations, 75
Peter D. Peng and Timothy M. Pawlik

12 Rival scoring systems: do they offer more?, 81
Angelo Sangiovanni and Massimo Colombo

13 Is it possible to detect early lesions effectively?, 91
Ryota Masuzaki and Masao Omata

14 What is the value of country-based surveillance programmes?, 97
Peter Ott

Part 4: Choice of Radiological Diagnostic Technique

15 Computed tomography or magnetic resonance imaging for the diagnosis of hepatocellular carcinoma, 107
Wladyslaw Gedroyc

16 Is Microbubble ultrasound useful?, 114
Adrian Lim

17 Value of PET scanning, 118
Tara D. Barwick, Imene Zerizer, and Adil Al-Nahhas

Part 5: Can Treatment be Tailored to the Patient?

18 Who could benefit from chemoembolisation?, 127
Gisele N'Kontchou, Olivier Seror, and Michel Beaugrand

19 Are drug-eluting beads worth using?, 136
Christopher N. Hacking and Pradesh Kumar

20 What is the future of image-guided radiofrequency ablation for hepatocellular carcinoma?, 142
Riccardo Lencioni

21 Alternative ablation techniques for hepatocellular carcinoma, 149
John Karani

22 Justification for sorafenib and chemotherapy, 154
Philip J. Johnson

23 When to consider surgery?, 160
Emmanuel Melloul, Mickael Lesurtel, and Pierre-Alain Clavien

24 Transplant considerations, 168
Myron Schwartz

Part 6: What Does the Future Hold?

25 Dipstick markers for diagnosis: feasible or not?, 179
Mohamed I.F. Shariff and Simon D. Taylor-Robinson

26 Targeted gene therapy for hepatocellular carcinoma: a reality?, 184
Christopher Binny, Marco Della Peruta, and Amit C. Nathwani

27 Is immune modulation a possibility?, 191
Tim F. Greten and Firouzeh Korangy

28 Systemic therapy for hepatocellular carcinoma: future directions, 199
Daniel H. Palmer, Matthew E. Cramp

Index, 212

Colour plate section can be found facing page 86