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A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma
  1. T J S Cross1,
  2. A Villaneuva2,
  3. S Shetty3,
  4. E Wilkes4,
  5. P Collins5,
  6. A Adair6,
  7. R L Jones7,
  8. M R Foxton8,
  9. T Meyer9,
  10. N Stern10,
  11. U Warshow11,
  12. N Khan12,
  13. M Prince13,
  14. S Khakoo14,
  15. G J Alexander15,
  16. S Khan16,
  17. H Reeves17,
  18. Aileen Marshall18,
  19. R Williams19
  20. on behalf of the Hepatocellular Carcinoma UK (UK HCC) Study Group
  1. 1Department of Hepatology, The Royal Liverpool Hospital, Liverpool, UK
  2. 2Institute of Liver Studies, Kings College Hospital, London, UK
  3. 3The Liver Unit, Queen Elizabeth Hospital II Hospital, Birmingham,  UK
  4. 4Digestive Diseases Unit, Queens Medical Centre, Nottingham,  UK
  5. 5Department of Hepatology, Bristol Royal Infirmary, Bristol, UK
  6. 6Scottish Liver Transplant Unit, Edinburgh, UK
  7. 7Department of Hepatology and Liver Transplantation, St James University Hospital, Leeds, UK
  8. 8Department of Gastroenterology, Chelsea and Westminster Hospital, Liverpool, UK
  9. 9Department of Oncology, The Royal Free Hospital, London, UK
  10. 10Department of Hepato-Biliary Medicine, Aintree University Hospital, Liverpool, UK
  11. 11The Southwest Liver Unit, Derriford Hospital, Plymouth, UK
  12. 12The Royal Marsden Hospital, London, UK
  13. 13Department of Gastroenterology and Hepatology, Manchester, UK
  14. 14Department of Academic and Translational Medicine, University of Southampton, Southampton, UK
  15. 15Department of Hepatology and Liver Transplant Medicine, Addenbrooke's Hospital, Cambridge, UK
  16. 16The Liver Unit, St Mary Hospital, London, UK
  17. 17Department of Hepatology and Liver Transplantation, Freeman Hospital, Newcastle-on-Tyne, UK
  18. 18The Sheila Sherlock Liver Centre, The Royal Free Hospital, London, UK
  19. 19Institute of Hepatology, Foundation for Liver Research, London, UK
  1. Correspondence to Dr Timothy J S Cross, Department of Hepatology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK; tim.cross{at}rlbuht.nhs.uk

Abstract

Objective Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings.

Design UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals.

Results Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%).

Conclusions In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.

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