title: Alcohol and hepatocellular carcinoma: a review and a point of view.
abstract: It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma (HCC) is alcohol consumption. Research in Italy and the United States concludes that the most common cause of HCC (responsible for 32% to 45% of HCC) is alcohol. It has recently been shown that a significant relationship between alcohol intake, metabolic changes, and hepatitis virus infection does exist. Alcohol may be a factor in the development of HCC via direct (genotoxic) and indirect mechanisms (cirrhosis). There is only one way of diagnosing HCC, which is early identification through surveillance, when curative treatments become possible. After stopping alcohol intake the risk of liver cancer decreases by 6% to 7% a year, and an estimated time period of 23 years is also needed. Therefore, surveillance is also important in former drinkers and, in our opinion, independently from the presence of compensated cirrhosis. In cases of very early stage (VES) and early stage with portal hypertension, liver transplantation is the optimal option; and in cases of associated disease, percutaneous ethanol injections, radiofrequency and microwave ablation are the ideal treatments. Despite the possibility of detecting microvascular invasion with HR, several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR. Therefore, ablation can be regarded as a first-line choice for patients with VES HCC. It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.
authors.affiliation: Gianni Testino, Paolo Borro, Centro Alcologico Regionale-Regione Liguria, Alcoholic Unit, Department of General Internal and Specialist Medicine, IRCCS AOU San Martino-National Institute for Cancer Research-IST, 16100 Genova, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Testino
authors.affiliation: Gianni Testino, Paolo Borro, Centro Alcologico Regionale-Regione Liguria, Alcoholic Unit, Department of General Internal and Specialist Medicine, IRCCS AOU San Martino-National Institute for Cancer Research-IST, 16100 Genova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Leone
authors.affiliation: Gianni Testino, Paolo Borro, Centro Alcologico Regionale-Regione Liguria, Alcoholic Unit, Department of General Internal and Specialist Medicine, IRCCS AOU San Martino-National Institute for Cancer Research-IST, 16100 Genova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borro
mesh_terms: D055011:Ablation Techniques; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000401:mortality / Q000517:prevention & control; D000818:Animals; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D055088:Early Detection of Cancer; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Alcohol; Alcoholic liver disease; Hepatocellular carcinoma; Percutaneous ablation