Origin and treatment of hepatocellular carcinoma (HCC)

Ⅰ. Introduction
The number of deaths of primary liver cancer in our country increased from 8291 (1958) to 34637 (2002). By gender, men were 23,815 (2002), women was 11822 (2002). After that, the number of deceased people has decreased, but it exceeds 30,000 a year in the past.
Possible cause of decrease in the number of liver cancer deaths are as follows:
1) Increase in other diseases and deaths due to the aging of the age group of primary liver cancer
2) Diffusion of periodic imaging diagnosis for hepatitis virus positive people accounting for approximately 90% of patients Increase in early detection cases by
③ Increase in carcinogenesis by antiviral therapy
④ Advances in the treatment of liver cancer

may be considered. 
However, because hepatocellular carcinoma is poor in subjective symptoms, it is still found in advanced hepatocellular carcinoma, except for patients who are enclosed as high-risk group of liver cancer and regular imaging diagnosis is done Current situation is that there are many cases.
Progressive hepatocellular carcinoma is not clearly defined, but (
1) giant liver cancer with a maximum tumor size greater than 10 cm (
2) cases with advanced vascular invasion (
3) multiple cases in the liver (
4)
a case with distant metastasis is advanced In addition, it is difficult to treat patients with hepatopathy degree C or Child-PughC in which the liver reserve capacity has decreased. For each case, it is a principle to accurately grasp the pathology such as primary tumor, vascular invasion, metastatic lesion, liver reserve and the like, and to perform custom-made treatment according to each case in principle, and a multidisciplinary treatment is desired I will.

Ⅱ. Origin of hepatocellular carcinoma
Cirrhosis and liver cancer in Asian countries are dominated by HBV-positive individuals. For example, in Korea, 74% of liver cancer is positive for HBs antigen, HCV antibody positivity is 9%, alcoholicity is only 7%, while the cause of cirrhosis and liver cancer in our country is few HBV and HCV positive It is occupied principally. At the 44 th Annual Meeting of the Japanese Society of Hepatology held in 2008, results of each institution were gathered from the main facilities nationwide, and the causes were analyzed for 17262 cases of liver cirrhosis (FIG. 1) and 16117 cases of hepatocellular carcinoma (FIG. 2) It was. In Japan overall, 73% of liver cancer is positive for HCV antibody, 14% is positive for HBs antigen, and it is very different from South Korea's achievement. In Japan, the cause of cirrhosis of cirrhosis has been investigated 5 times from the General Assembly of the Japanese Gastroenterology Society of 1983 to the Japan Society of Hepatic Societies in 2011. B type hepatocellular carcinoma is almost constant in the number of deceased but due to the increase in type C hepatocellular carcinoma the proportion of type B has decreased from 23.3% in 1983 to 13.1% in 2011 I will. In addition, in the results after 1998, which is a survey after the diagnosis of HCV was established, the non-B non-C type increased from 21.8% to 26.2%. It is believed that both B and C hepatocellular carcinomas will decrease in the future and non-B non-C hepatocellular carcinomas such as NASH (nonalcoholic steatohepatitis) liver cancer will increase.

Ⅲ. Progression classification of hepatocellular carcinoma and treatment algorithm
Progression classification and prognosis
The degree of progression of hepatocarcinoma described in the handling regulation of primary liver cancer is classified as Stage I to IV according to the highest numerical value of each patient by obtaining the progress value of that patient by each item. Life prognosis of hepatocellular carcinoma greatly influences not only tumor progression but also liver reserve. In the treatment regulations for primary liver cancer, we present classification of hepatopathy degree incorporating ICG burden test instead of hepatic encephalopathy in Child-Pugh classification. The 5-year survival rate of hepatectomized cases was 59%, 45.3%, and 35.0% for liver damage degree A, B, and C, respectively.

Ⅴ. in conclusion
Even at our hospital, any treatment other than liver transplantation is possible, but it is important to start treatment at the stage of chronic hepatitis because it is not cancer. For hepatitis C, it changed from traditional interferon treatment to treatment with oral medicine, and more than 90% virus removal became possible. Also in hepatitis B it has become possible to stabilize hepatitis and prevention of cancer with nucleic acid analog formulation. Early diagnosis of NASH (nonalcoholic steatohepatitis), which is expected to increase in the future, will lead to the prevention of NASH liver cancer.