الفهرس 
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Abstract
Hepatocellular carcinoma (HCC), or hepatoma,is the fifth most common of all malignancies worldwide and results in approximately one million deaths annually (Yu and Keeffe, 2003).
Although the incidence of HCC is highest in parts of Africa and Asia, recent studies have documented a clear rise in the number of cases in Western Europe, Japan, and the United States (Choti, 2000).
More than 80% of HCC cases occur in the setting of cirrhosis associ¬ated with chronic infection with hepatitis B or C virus and exposure to aflatoxin B (Thomas and Abbruzzese, 2005).
Various classification systems are available for HCC. The Barcelona Clinic Liver Cancer (BCLC) classification has emerged during recent years as the standard classification that is used for trial design and clinical management of patients with HCC. This classification has been approved by EASL and the AASLD and has subsequently been corroborated in clinical studies. The BCLC staging system was constructed on the basis of the results obtained in the setting of several cohort studies and randomized controlled trials by the Barcelona group.
The main prognostic factors of this staging system are related to tumour status (defined by the number and size of nodules, the presence or absence of vascular invasion, and the presence or absence of extrahepatic spread), liver function (defined by the Child-Pugh score system, serum bilirubin and albumin levels, and portal hypertension), and general health status [defined by the Eastern Cooperative Oncology Group (ECOG), classification and presence of symptoms]. On the other hand, aetiology is not an independent prognostic factor. The BCLC classification links stage stratification with a recommended treatment strategy and defines standard of care for each tumour stage (Figure 14) (Rampone et al., 2009).
Figure 14: Barcelona Clinic Liver Cancer staging classification and treatment schedule (Rampone et al., 2009).
For patients who are not candidatesfor liver resection or transplantation, percutaneous ablation offers the best treatment option. However, to our knowledge, there are no randomized controlled clinical trials that have compared the results of this treatment option with those of surgical therapy for HCC, and none of the ablation techniques have been shown to offer a definitive survival advantage. The principle of ablation is based on the destruction of tumour cells by the application of chemical substances, such as ethanol, or by using RF or laser to modify the temperature in the tumour via the delivery of heat. Of all those techniques, PEI has been the most investigated (Rampone et al., 2009). Surgical interventions are feasible in only a small proportion of patients, and non-surgical therapy has been frequently administered to patients with inoperable HCC. Various modalities of loco-regional therapy have gained much interest during the past decade. Among them, transarterial chemoembolization (TACE), percutaneous injection of ethanol (PEI) or acetic acid (PAI), radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) are effective treatment options (Lee and Huo, 2004).