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TREATMENT DECISION has been generally proposed as the backbone of the
HCCs treatment that has been approved by the European
There are numerous classifications and staging systems for Association for the Study of the Liver and American
[7]
planning the treatment of HCCs, but every HCC and every Association for the Study of Liver Diseases. The system
patient must be evaluated individually. Treatment options for encounters the size, number, extrahepatic dissemination, and
HCC have a wide range of modalities that change according vascular invasion of the tumor. It also uses the Child-Pugh
to the stage of the tumor and the patient specific factors. score system for the liver function, examines the presence of
portal hypertension, and the Eastern Cooperative Oncology
In 70% of the HCC cases, the treatment modalities used are Group (ECOG) classification for the health status of the
not for curative intent. When diagnosed, 50% of HCC patients patient. Every detail and finding about the HCC and the
[8]
are suitable only for some palliative treatment modalities patient is important in deciding the right stage, treatment
such as transarterial chemoembolization, chemotherapy, choice, prognosis, and outcome of the disease. Hence,
and sorafenib, which are proven to be effective on the HCCs evaluation and the content of the staging systems must be
by giving a median survival of 11-12 months at max. For the well-known by the surgeons to avoid a misdiagnosis or an
remaining 20% of the patients, symptomatic and supportive overtreatment that is in-effective and un-necessary for the
treatments can be used within a very limited survival period patients. The only handicap of the staging systems, scores,
of < 3 months. The curative intent treatment modalities grading systems, classifications, algorithms, charts is the
[4]
vary among a simple curative resection of the HCC, ablative difficulty in memorizing, remembering, and/or recalling the
methods, and liver transplantation, and these methods are contents of them. Moreover, most of these systems do not
usually suitable in patients with small size HCCs. However, include any data about surgical details such as extent of liver
these curative treatment options may be possible only for 30% resection, intra-hepatic distribution of the tumor(s), and the
[4]
of all the HCCs with 5-year survival rates of 40-70%. Liver technical feasibility of the resection that are all vital for the
transplantation itself has an advantage over other curative surgeons in deciding the surgical resections of HCCs.
therapies by eliminating both the HCC and the underlying
cirrhosis. However, resections and ablations for a curative TRICKS AND TREATS TO LEARN, REMEMBER AND
intent should also be preferred because of the limited RECALL
shortage of donors. The incidence of the HCCs is increased
in years from 2.8 per 100,000 in 1979 up to 4.6 per 100,000 There have been numerous learning techniques and strategies
in 1999. Every year over 571,000 new cases are diagnosed described in time to simplify learning, to make memorizing
with HCCs, most of them (44%) from China. Annually, processes easy, and to ease recalling of them from memory
552,000 deaths due to HCCs or HCC related consequences when they are needed. When there is a list of items, steps or
[5]
are seen worldwide. It is estimated that nearly 20,000 words to be remembered in a sequence, the first letters of
liver transplantations are annually performed all around the these words is written one after the other and that formed
world for all indications. When compared to the annual cases word or the phrase is called a mnemonic acronym. This
diagnosed and yearly deaths seen due to HCCs, this overall acronym can be used to remember the right words in the
transplantation number is more than insufficient. That’s right order. It is proven that this strategy makes the learning,
why these resections and local ablative methods must be memorizing, and recalling processes much more easier. [9,10]
performed much more frequently in every HCC case possible
to improve survival rates at different stages if possible. The mnemonic acronym is defined as an invented combination
of letters for this purpose. The acronym formed from the
HOW TO DECIDE: WHICH WAY TO GO? WHAT TO DO? initials may be a meaningful word, sentence, phrase, or
a nonsense phrase for example like “PVT TIM HALL”. This
HCCs’ stage evaluation is essential to decide on the treatment is a mnemonic acronym used by the medical students to
modality to be chosen. The stage of the disease and the remember the essential amino acids. These amino acids are
status of the patient give an idea about the resectability, the Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine,
prognosis and the therapy to be chosen for the HCCs. There Methionine, Histidine, Arginine, Leucine, and Lysine.
are various staging systems applied for staging of the HCCs Sometimes the mnemonic acronyms formed may be a
in the literature such as Barcelona Clinic Liver Cancer (BCLC), meaningful word or phrase related to the original sentence,
Cancer of the Liver Italian Program, Group Study, and which is much more favorable due to the ease of recalling and
Treatment of Hepatocellular Carcinoma, Chinese University remembering the acronym too. The example for this can be
Prognostic Index, Japan Integrated Staging, and Okuda or the total parenteral nutrition (TPN) indication, which is the
Tokyo. From these staging systems, the BCLC classification phrase “MISIPPI Burning”. Here, the word is composed of the
[6]
166 Hepatoma Research | Volume 1 | Issue 3 | October 15, 2015