Increasing & Peaking Cirrhosis, Decompensated Cirrhosis & HCC(liver cancer) in UK Projected

From The Executive Director Of NATAP: Jules Levin

Increasing & Peaking Cirrhosis, Decompensated Cirrhosis & HCC(liver cancer) in UK Projected

From Jules: these projections are no different as what has been projected in the USA.
The HCV epidemic started 30 years ago so infected patients' disease obviously has been advancing to now where it's estimated advanced liver disease is peaking & death rates will increase over the next 12 years leaving an approaching brief window to identify undiagnosed patients (its estimated that two-thirds to three-fourths of patients remain undiagnosed), and to provide care & treatment. This epidemiologic event dovetails with emerging new anticiapted high cure rates due to the many new HCV treatments emerging beginning now with 10-15 new drugs in development. Within several years we expect like in HIV multi-drug antiviral orally administered therapy. The most recent research development was presented in a study at EAL the European annual liver conference in April 2011 reporting patients were cured with a combination of 2 oral drugs without peginterferon/ribavirin (these were prior null responder patients the hardest to treat) which provides proof of concept that at least some patients can be cured without peg/rbv, perhaps all, so ongoing studies will be trying to confirm the extent of this possibility. 
Estimating the incidence and prevalence of Hepatitis C infection in England using backprojection methods - see attached full poster report... See Full Data At NATAP

Histological diagnosis (markers) of early hepatocellular carcinoma - Editorial -
The definition of malignancy classically requires that there be uncontrolled growth of tissue. There are histological correlates of this behavior, and this correlation is absolute in late-stage tumors. If it looks like a malignancy on histological examination, the lesion will exhibit uncontrolled growth. However, at the earliest stages of malignancy, the correlation between histological appearances and malignant behavior may not be so clear. In very early hepatocellular carcinoma (HCC), for example, although there are features suggesting malignancy, such as stromal invasion, the malignant nature of these lesions (i.e., uncontrolled growth) has not been demonstrated. Furthermore, at the boundary between premalignant and malignant states, it is difficult to identify morphological correlates of malignant behavior, because dysplasia and early neoplasia share many common histological features. Although dysplasia is a precursor to malignancy, not all dysplastic lesions ultimately develop malignancy. Some, admittedly a minority, may even disappear. Others remain unchanged in size for years before ultimately developing malignancy. By the strict definition of malignancy, whatever radiological or histological characteristics a lesion may have, if it does not grow, it is not malignant, and therefore may not need treatment.... See Full Text At NATAP

Comments on the International Liver Cancer Association Fourth Annual Conference, 2010. Is there really no role for liver biopsy interpretation in liver cancer? - Comments from the Editors

Hepatology March 2011

Elizabeth M. Brunt M.D.1,*,, Gregory Gores M.D.2

As I write my final Associate Editor Commentary, I would first like to acknowledge the distinct privilege and honor it has been to be a member of the Associate Editor Board for the "Lindor" years of HEPATOLOGY. I have enjoyed my service to the American Association for the Study of Liver Diseases, as well as both the pathology and liver disease communities. Frankly, I will not, however, miss the difficult choices that are necessary in this position.

Writing this Commentary, however, largely by the encouragement and invitation of coauthor Gregory Gores, has not been one of the difficult choices of my career! For some background: The International Liver Cancer Association (ILCA) held its fourth annual conference in September in Montreal, Canada. As an invited member for the first meeting of the society, and with a long-standing interest in the pathology of liver cancer, I had only missed one other meeting to date. I was looking forward to presenting a poster that might stir discussion and interest in the outcome of HCC after transplant with certain histopathologic/immunohistochemical findings that were previously reported to be poor prognosticators, but that in our series had not correlated with adverse outcome. However, after the first day of the presentations, as excellent as they were, the message was clear: -omics, gene arrays, micro-RNAs, and biomarker assay development were "in", and further, most appeared not to involve the "services" or expertise of prior histopathologic evaluation of the tissues on which they were based......See Full Text At NATAP