T J S Cross1, A Villanueva2, S Shetty3, E Wilkes4, P Collins5, A Adair6, R L Jones7, M R Foxton8, T Meyer9, N Stern10, U Warshow11, N Khan12, M Prince13, S Khakoo14, G J Alexander15, S Khan16, H Reeves17, Aileen Marshall18, R Williams19. 1. Department of Hepatology, The Royal Liverpool Hospital, Liverpool, UK. 2. Institute of Liver Studies, Kings College Hospital, London, UK. 3. The Liver Unit, Queen Elizabeth Hospital II Hospital, Birmingham, UK. 4. Digestive Diseases Unit, Queens Medical Centre, Nottingham, UK. 5. Department of Hepatology, Bristol Royal Infirmary, Bristol, UK. 6. Scottish Liver Transplant Unit, Edinburgh, UK. 7. Department of Hepatology and Liver Transplantation, St James University Hospital, Leeds, UK. 8. Department of Gastroenterology, Chelsea and Westminster Hospital, Liverpool, UK. 9. Department of Oncology, The Royal Free Hospital, London, UK. 10. Department of Hepato-Biliary Medicine, Aintree University Hospital, Liverpool, UK. 11. The Southwest Liver Unit, Derriford Hospital, Plymouth, UK. 12. The Royal Marsden Hospital, London, UK. 13. Department of Gastroenterology and Hepatology, Manchester, UK. 14. Department of Academic and Translational Medicine, University of Southampton, Southampton, UK. 15. Department of Hepatology and Liver Transplant Medicine, Addenbrooke's Hospital, Cambridge, UK. 16. The Liver Unit, St Mary Hospital, London, UK. 17. Department of Hepatology and Liver Transplantation, Freeman Hospital, Newcastle-on-Tyne, UK. 18. The Sheila Sherlock Liver Centre, The Royal Free Hospital, London, UK. 19. Institute of Hepatology, Foundation for Liver Research, London, UK.
Abstract
OBJECTIVE: Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings. DESIGN: UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals. RESULTS: Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%). CONCLUSIONS: In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.
OBJECTIVE:Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings. DESIGN: UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals. RESULTS: Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%). CONCLUSIONS: In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.
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