Hepatocellular Carcinoma: The Final Moments of Life


Hepatocellular carcinoma (HCC) is a wide world prevalent hepatic disease, being the third greater cancer related death cause and most of the patients are not eligible for liver transplant. Palliative care is an option for, in average, half of hepatocellular carcinoma diagnosed patients and only recently the molecular targeted drug, Sorafenib, has been introduced among the therapeutic options for these patients. The physical pain comes frequently associated with progression disease (metastasis). Patients may be very fragile, with immobility, loss of interest in food and beverage intake, as well as weakness and drowsiness. Therefore, it is important that health professionals start planning care with patients and their relatives, before the end-stage disease. Informing the patient about therapeutic options guarantee a doctor patient relationship improvement and more belief on the health team.

Share and Cite:

R. Abreu, C. Ferreira, P. Nasser, L. Kikuchi, F. Carrilho and S. Ono, "Hepatocellular Carcinoma: The Final Moments of Life," Journal of Cancer Therapy, Vol. 4 No. 2A, 2013, pp. 377-383. doi: 10.4236/jct.2013.42A045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. K. Chiang, M. Koo, T. B. Kuo and C. H. Fu, “Association between cardiovascular Autonomic Functions and Time to Death in Patients with Terminal Hepatocellular Carcinoma,” Journal of Pain and Symptom Management, Vol. 39, No. 4, 2010, pp. 673-679. doi:10.1016/j.jpain symman.2009.09.014
[2] J. F. Geschwind, “Chemoembolization for Hepatocellular Carcinoma: Where Does the Truth Lie?” Journal of Vascular and Interventional Radiology, Vol. 13, No. 10, 2002, pp. 991-994. doi:10.1016/S1051-0443(07)61862-4
[3] J. M. Llovet, A. M. Di Bisceglie, J. Bruix, B. S. Kramer, R. Lencioni, A. X. Zhu, et al., “Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma,” Journal of the National Cancer Institute, Vol. 100, No. 10, 2008, pp. 698-711. doi:10.1093/jnci/djn134
[4] J. Muntané, R. González, I. Ranchal, J. A. Collado, L. M. López-Sánchez, C. Herencia, et al., “Mechanisms of Liver Cell Injury,” Revista Espanola de Enfermedades Digestivas, Vol. 99, No. 7, 2007, pp. 405-410. doi:10.4321/S1130-01082007000700007
[5] S. Bruno, A. Crosignani, P. Maisonneuve, S. Rossi, E. Silini and M. Mondelli, “Hepatitis C Virus Genotype 1b as a Major Risk Factor Associated with Hepatocellular Carcinoma in Patients with Cirrhosis: A Seventeen-Year Prospective Cohort Study,” Hepatology, Vol. 46, No. 5, 2007, pp. 1350-1356. doi:10.1002/hep.21826
[6] M. E. Nita, V. A. Alves, F. J. Carrilho, S. K. Ono-Nita, E. S. Mello and J. J. Gama-Rodrigues, “Molecular Aspects of Hepatic Carcinogenesis,” Revista do Instituto de Medicina Tropical de Sao Paulo, Vol. 44, No. 1, 2004, pp. 39-48. doi:10.1590/S0036-46652002000100007
[7] H. I. Yang, S. H. Yeh, P. J. Chen, U. H. Iloeje, C. L. Jen, J. Su, et al., “Associations between Hepatitis B Virus Genotype and Mutants and the Risk of Hepatocellular Carcinoma,” Journal of the National Cancer Institute, Vol. 100, No. 16, 2008, pp. 1134-1143. doi:10.1093/jnci/djn243
[8] H. I. Yang, M. Sherman, J. Su, P. J. Chen, Y. F. Liaw, U. H. Iloeje, et al., “Nomograms for Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Virus Infection,” Journal of Clinical Oncology, Vol. 28, No. 14, 2010, pp. 2437-2444. doi:10.1200/JCO.2009.27.4456
[9] K. Lertpipopmetha and C. U. Auewarakul, “High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis,” BMC Gastroenterology, Vol. 11, 2011, p. 66. doi:10.1186/1471-230X-11-66
[10] E. E. Calle, C. Rodriguez, K. Walker-Thurmond and M. J. Thun, “Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of US Adults,” The New England Journal of Medicine, Vol. 348, No. 17, 2003, pp. 1625-1638. doi:10.1056/NEJMoa021423
[11] M. Colombo, R. de Franchis, E. Del Ninno, A. Sangiovanni, C. De Fazio, M. Tommasini, et al., “Hepatocellular Carcinoma in Italian Patients with Cirrhosis,” The New England Journal of Medicine, Vol. 325, No. 10, 1991, pp. 675-680. doi:10.1056/NEJM199109053251002
[12] H. Tsukuma, T. Hiyama, S. Tanaka, M. Nakao, T. Yabuuchi, T. Kitamura, et al., “Risk Factors for Hepatocellular Carcinoma among Patients with Chronic Liver Disease,” The New England Journal of Medicine, Vol. 328, No. 25, 1993, pp. 1797-1801. doi:10.1056/NEJM199306243282501
[13] F. J. Carrilho, L. Kikuchi, F. Branco, C. S. Goncalves, A. A. Mattos, Brazilian HCC Study Group, “Clinical and Epidemiological Aspects of Hepatocellular Carcinoma in Brazil,” Clinics, Sao Paulo, Vol. 65, No. 12, 2010, pp. 1285-1290. doi:10.1590/S1807-59322010001200010
[14] M. H. Lin, P. Y. Wu, S. T. Tsai, C. L. Lin, T. W. Chen and S. J. Hwang, “Hospice Palliative Care for Patients with Hepatocellular Carcinoma in Taiwan,” Palliative Medicine, Vol. 18, No. 2, 2004, pp. 93-99. doi:10.1191/0269216304pm851oa
[15] J. M. Llovet, J. Fuster and J. Bruix, “Intention-to-Treat Analysis of Surgical Treatment for Early Hepatocellular Carcinoma: Resection versus Transplantation,” Hepatology, Vol. 30, No. 6, 1999, 1434-1440. doi:10.1002/hep.510300629
[16] M. Varela, M. Sala, J. M. Llovet and J. Bruix, “Treatment of Hepatocellular Carcinoma: Is There an Optimal Strategy?” Cancer Treatment Reviews, Vol. 29, No. 2, 2003, pp. 99-104. doi:10.1016/S0305-7372(02)00123-8
[17] A. T. Chan, P. Jacobs, W. Yeo, M. Lai, C. B. Hazlett, T. S. Mok, et al., “The Cost of Palliative Care for Hepatocellular Carcinoma in Hong Kong,” Pharmacoeconomics, Vol. 19, No. 9, 2001, pp. 947-953. doi:10.2165/00019053-200119090-00006
[18] G. Masera, J. J. Spinetta, M. Jankovic, A. R. Ablin, G. J. D’Angio, J. Van Dongen-Melman, et al., “Guidelines for Assistance to Terminally Ill Children with Cancer: A Report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology,” Medical and Pediatric Oncology, Vol. 32, No. 1, 1999, pp. 44-48. doi:10.1002/(SICI)1096-911X(199901)32:1<44::AID-MPO9>3.0.CO;2-P
[19] C. L. C. Brandao, V. C. Aranha, T. Chiba, J. Quayle and M. C. S. D. Lucia, “A Imagem Corporal do Idoso Com Cancer Atendido No Ambulatório de Cuidados Paliativos do ICHC-FMUSP,” Psicologia Hospitalar, Vol. 2, 2004.
[20] S. Postovsky, A. Levenzon, R. Ofir and M. W. Ben Arush, “‘Do Not Resuscitate’ Orders among Children with Solid Tumors at the End of Life,” Journal of Pediatric Hematology/Oncology, Vol. 21, No. 7, 2004, pp. 661-668. doi:10.1080/08880010490501088
[21] A. M. Larson and J. R. Curtis, “Integrating Palliative Care for Liver Transplant Candidates: Too Well for Transplant, Too Sick for Life,” Journal of the American Medical Association, Vol. 295, No. 18, 2006, pp. 2168-2176. doi:10.1001/jama.295.18.2168
[22] L. Hansen, A. Sasaki and B. Zucker, “End-stage Liver Disease: Challenges and Practice Implications,” Nursing Clinics of North America, Vol. 45, No. 3, 2010, pp. 411- 426. doi:10.1016/j.cnur.2010.03.005
[23] A. Gulinelli, R. K. Aisawa, S. N. Konno, C. V. Morinaga, W. L. Costardi, R. O. Antonio, et al., “Desejo de Informacao e Participacao nas Decisoes terapêuticas em Caso de Doencas graves em Pacientes Atendidos em um Hospital Universitário,” Revista da Associacao Médica Brasileira, Vol. 50, No. 1, 2004, pp. 41-47. doi:10.1590/S0104-42302004000100033
[24] F. S. Santos, “Cuidados Paliativos: Discutindo a Vida, a Morte e o Morrer,” 1 Edition, Atheneu, Rio de Janeiro, 2009, 476 Pages.
[25] WHO, “National Cancer Control Programmes: Policies and Managerial Guidelines,” World Health Organization, Geneva, 2002.
[26] M. Kudo and T. Okanoue, “Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Manual Proposed by the Japan Society of Hepatology,” Oncology, Vol. 72, Suppl. 1, 2007, pp. 2-15. doi:10.1159/000111702
[27] A. Lock and I. Higginson, “Patterns and Predictors of Place of Cancer Death for the Oldest Old,” BMC Palliative Care, Vol. 4, 2005, p. 6. doi:10.1186/1472-684X-4-6
[28] J. Bruix and M. Sherman, “Management of Hepatocellular Carcinoma: An Update,” Hepatology, Vol. 53, No. 3, 2011, pp. 1020-1022. doi:10.1002/hep.24199
[29] P. S. Kamath, R. H. Wiesner, M. Malinchoc, W. Kremers, T. M. Therneau, C. L. Kosberg, et al., “A model to Predict Survival in Patients with End-Stage Liver Disease,” Hepatology, Vol. 33, No. 2, 2001, pp. 464-470. doi:10.1053/jhep.2001.22172
[30] K. Dalhoff, J. Dancey, L. Astrup, T. Skovsgaard, K. J. Hamberg, F. J. Lofts, et al., “A Phase II Study of the Vitamin D Analogue Seocalcitol in Patients with Inoperable Hepatocellular Carcinoma,” British Journal of Cancer, Vol. 89, No. 2, 2003, pp. 252-257. doi:10.1038/sj.bjc.6601104
[31] J. M. Llovet, M. I. Real, X. Montana, R. Planas, S. Coll, J. Aponte, et al., “Arterial Embolisation or Chemoembolisation versus Symptomatic Treatment in Patients with Unresectable Hepatocellular Carcinoma: A Randomised Controlled Trial,” Lancet, Vol. 359, 9319, 2002, pp. 1734-1739. doi:10.1016/S0140-6736(02)08649-X
[32] M. Biselli, P. Andreone, A. Gramenzi, F. Trevisani, C. Cursaro, C. Rossi, et al., “Transcatheter Arterial Chemoembolization Therapy for Patients with Hepatocellular Carcinoma: A Case-Controlled Study,” Clinical Gastroenterology and Hepatology, Vol. 3, No. 9, 2005, 918-925. doi:10.1016/S1542-3565(05)00425-8
[33] Y. S. Chang, J. Adnane, P. A. Trail, J. Levy, A. Henderson, D. Xue, et al., “Sorafenib (BAY 43-9006) Inhibits Tumor Growth and Vascularization and Induces Tumor Apoptosis and Hypoxia in RCC Xenograft Models,” Cancer Chemotherapy and Pharmacology, Vol. 59, No. 5, 2007, pp. 561-574. doi:10.1007/s00280-006-0393-4
[34] S. M. Wilhelm, C. Carter, L. Tang, D. Wilkie, A. McNabola, H. Rong, et al., “BAY 43-9006 Exhibits Broad Spectrum Oral Antitumor Activity and Targets the RAF/MEK/ERK Pathway and Receptor Tyrosine Kinases Involved in Tumor Progression and Angiogenesis,” Cancer Research, Vol. 64, No. 19, 2004, pp. 7099-7109. doi:10.1158/0008-5472.CAN-04-1443
[35] J. M. Llovet, S. Ricci, V. Mazzaferro, P. Hilgard, E. Gane, J. F. Blanc, et al., “Sorafenib in Advanced Hepatocellular Carcinoma,” The New England Journal of Medicine, Vol. 359, 4, 2008, pp. 378-390. doi:10.1056/NEJMoa0708857
[36] A. Vitale, M. L. Volk, D. Pastorelli, S. Lonardi, F. Farinati, P. Burra, et al., “Use of Sorafenib in Patients with Hepatocellular Carcinoma before Liver Transplantation: A Cost-Benefit Analysis While Awaiting Data on Sorafenib Safety,” Hepatology, Vol. 51, No. 1, 2010, pp. 165-173. doi:10.1002/hep.23260
[37] I. Duran, S. J. Hotté, H. Hirte, E. X. Chen, M. MacLean, S. Turner, et al., “Phase I Targeted Combination Trial of Sorafenib and Erlotinib in Patients with Advanced Solid Tumors,” Clinical Cancer Research, Vol. 13, No. 16, 2007, pp. 4849-4857. doi:10.1158/1078-0432.CCR-07-0382
[38] A. Villanueva and J. M. Llovet, “Targeted Therapies for Hepatocellular Carcinoma,” Gastroenterology, Vol. 140, No. 5, 2011, pp. 1410-1426. doi:10.1053/j.gastro.2011.03.006
[39] L. Rossi, F. Zoratto, A. Papa, F. Iodice, M. Minozzi, L. Frati, et al., “Current Approach in the Treatment of Hepatocellular Carcinoma,” World Journal of Gastrointestinal Oncology, Vol. 2, No. 9, 2010, pp. 348-359. doi:10.4251/wjgo.v2.i9.348
[40] W. Sun, D. Sohal, D. G. Haller, K. Mykulowycz, M. Rosen, M. C. Soulen, et al., “Phase 2 Trial of Bevacizumab, Capecitabine, and Oxaliplatin in Treatment of Advanced Hepatocellular Carcinoma,” Cancer, Vol. 117, No. 14, 2011, pp. 3187-3192. doi:10.1002/cncr.25889
[41] T. Livraghi, R. Ceriani, A. Palmisano, V. Pedicini, M. G. Pich, M. A. Tommasini, et al., “Complete Response in 5 out of 38 Patients with Advanced Hepatocellular Carcinoma Treated with Stem Cell Differentiation Stage Factors: Case Reports from a Single Centre,” Current Pharmaceutical Biotechnology, Vol. 12, No. 2, 2011, pp. 254-260. doi:10.2174/138920111794295855
[42] S. Okada, N. Okazaki, H. Nose, M. Yoshimori and K. Aoki, “Prognostic Factors in Patients with Hepatocellular Carcinoma Receiving Systemic Chemotherapy,” Hepatology, Vol. 16, No. 1, 1992, pp. 112-117. doi:10.1002/hep.1840160119
[43] J. M. Llovet, A. Burroughs and J. Bruix, “Hepatocellular Carcinoma,” Lancet, Vol. 362, No. 9399, 2003, 1907-1917. doi:10.1016/S0140-6736(03)14964-1
[44] D. F. Schafer and M. F. Sorrell, “Hepatocellular Carcinoma,” Lancet, Vol. 353, No. 9160, 1999, pp. 1253-1257. doi:10.1016/S0140-6736(98)09148-X
[45] LO Kikuchi, DC Paranaguá-Vezozzo, AL Chagas, ES Mello, VA Alves, AQ Farias, et al., “Nodules Less than 20 mm and Vascular Invasion Are Predictors of Survival in Small Hepatocellular Carcinoma,” Journal of Clinical Gastroenterology, Vol. 43, No. 2, 2009, pp. 191-195. doi:10.1097/MCG.0b013e31817ff199
[46] G. Cabibbo, M. Enea, M. Attanasio, J. Bruix, A. Craxì and C. Cammà, “A Meta-Analysis of Survival Rates of Untreated Patients in Randomized Clinical Trials of Hepatocellular Carcinoma,” Hepatology, Vol. 51, 4, 2010, pp. 1274-1283. doi:10.1002/hep.23485
[47] F. S. Santos, “Cuidados Paliativos: Diretrizes, Humanizacao e Alívio de Sintomas,” 1 Edition, Atheneu, Sao Paulo, 2011.
[48] J. Heyink, T. Tymstra, M. J. Sloof and C. Gips, “Liver Transplantation—The Rejected Patients,” Transplantation, Vol. 47, No. 6, 1989, pp. 1069-1071. doi:10.1097/00007890-198906000-00031
[49] J. Brown, J. H. Sorrell, J. McClaren and J. W. Creswell, “Waiting for a Liver Transplant,” Qualitative Health Research, Vol. 16, No. 1, 2006, pp. 119-136. doi:10.1177/1049732305284011
[50] E. Kübler-Ross, “Sobre a Morte e o Morrer,” 9 Edition, Martins Fontes, Sao Paulo, 2009, 304 Pages.?
[51] M. J. Kovács, “Educacao Para a Morte: Desafio na Formacao de Profissionais de Saúde e Educacao,” 2 Edition, Casa do Psicólogo, Sao Paulo, 2003, 176 Pages.
[52] A. G. Singal, M. L. Volk, M. O. Rakoski, S. Fu, G. L. Su, H. McCurdy, et al., “Patient Involvement in Healthcare Is Associated with Higher Rates of Surveillance for Hepatocellular Carcinoma,” Journal of Clinical Gastroenterology, Vol. 45, No. 8, 2011, pp. 727-732. doi:10.1097/MCG.0b013e31820989d3

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.