New medical options for liver tumours.

Significant progress is being made in the prevention of hepatitis B-related hepatocellular carcinoma (HCC) but hepatitis C-related HCC is increasing in the West and therapeutic advances in established disease have been modest. Although ablative therapies, including surgical resection, seem effective in patients with small tumours these only represent a minority of patients. For the majority with advanced disease there is some evidence for survival benefit for transarterial chemoembolisation but only in very carefully selected patients. Systemic chemotherapy is of unproven benefit and is now largely confined to clinical trials. In contrast, there has been a steady improvement in the outlook of patients with established metastatic liver cancer when the primary site is colorectal. Survival has increased from around six months to almost two years with the introduction of new cytotoxic agents, irinotecan and oxaliplatin. Somatostatin analogues have had a dramatic impact on the symptomatic control of neuroendocrine tumours, metastatic to the liver that result in the carcinoid syndrome.