Hepatoselluler Karsinom
Özet
Hepatosellüler Karsinom (HSK), karaciğerin en sık rastlanan primer tümörü olup dünya genelinde kansere bağlı ölümlerde dördüncü sırada yer almaktadır. Genellikle sirotik bir zeminde viral hepatit, alkol kullanımı veya alkol dışı yağlı karaciğer hastalığına bağlı olarak gelişir. Erken evrelerde semptom göstermemesi nedeniyle çoğunlukla ileri aşamalarda teşhis edilir; bu durum prognozu olumsuz etkiler. Risk altındaki popülasyonun ultrasonografi ve alfa-fetoprotein takibi ile taranması erken teşhis için kritik önem taşır. Tanı sürecinde kontrastlı bilgisayarlı tomografi ve manyetik rezonans görüntüleme gibi yöntemlerle tümörün tipik boyanma özellikleri incelenir, nadiren biyopsiye ihtiyaç duyulur. Tedavi yaklaşımı; hastanın genel performans durumuna, tümörün morfolojisine ve karaciğer fonksiyon rezervine göre belirlenir. Erken evrede cerrahi rezeksiyon ve karaciğer nakli küratif seçenekler sunarken, cerrahiye uygun olmayan hastalarda radyofrekans veya mikrodalga ablasyon ile transarteryel kemoembolizasyon gibi lokal tedaviler tercih edilir. İleri evre vakalarda ise kür şansı olmamakla birlikte sağkalımı uzatmak adına sorafenib, lenvatinib veya atezolizumab-bevacizumab kombinasyonu gibi sistemik ve hedefe yönelik ajanlar kullanılır.
Hepatocellular Carcinoma (HCC) is the most common primary tumor of the liver and ranks fourth among cancer-related deaths worldwide. It typically arises in a cirrhotic liver secondary to viral hepatitis, chronic alcohol consumption, or non-alcoholic fatty liver disease. Due to its asymptomatic nature in the early stages, it is frequently diagnosed late, which significantly worsens the prognosis. Surveillance of high-risk populations using ultrasonography and alpha-fetoprotein monitoring is critical for early detection. Diagnosis is primarily established through contrast-enhanced computed tomography or magnetic resonance imaging by evaluating typical vascular enhancement patterns, while biopsy is rarely required. Treatment decisions depend on the patient's performance status, tumor morphology, and liver function reserve. Surgical resection and liver transplantation offer curative options for early-stage disease, whereas local therapies such as radiofrequency or microwave ablation and transarterial chemoembolization are preferred for unresectable cases. In advanced stages, where curative treatment is not viable, systemic and targeted molecular therapies—including sorafenib, lenvatinib, or atezolizumab-bevacizumab combinations—are utilized to extend overall survival.
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