**2. Patient management**

**1. Introduction**

34 Liver Cancer

is timed well.

approach is needed.

cirrhotic impairment or therapeutical side effects.

recurrent illness, or metastatic disease either.

Hepatocellular carcinoma (HCC) is characterized by high clinical and biological variability

Treatment requires commonly to make a decision between several specific interventions and

Therapeutical approach shall take into account acute cirrhotic impairment risk and patient

Nowadays, patients older than 75 years account for 22% of HCC patients [2]. That is due to treatment and technological advancements which allow to reach an overall survival of decades, if therapy is well pondered; patients are kept in lifelong follow-up and intervention

Therapeutical approaches to treat HCC can be divided into surgical approaches, such as major hepatic resection, minor hepatic resection, and wedge resection. Nonsurgical approaches are interventional radiology, chemotherapy, and most recently hadrontherapy. Since people older in age frequently have several comorbidities, often a specific less invasive therapeutical

Age is not a good outcome predictor: fit elderly patients may tolerate radical and invasive approaches, while unfit patients may not [3]. Treatment of older adults must take into account multiple issues related to the condition of aging itself. First of all, patient's frailty, thus invasive approaches are commonly excluded in patients advanced in age; on the other hand, noninvasive treatments are often palliative and do not achieve a satisfactory disease-free survival (DFS) or long-term survival (LTS) [3, 4]. Into this complex scenario, treatment strategies should also consider obstacles to cure the patients either physical or psychological, illness awareness, linguistic or cultural barriers, poverty, depression, and family environment.

Giving indication for or against invasive treatments is arduous in elderly. A decision for intervention shall consider either oncological principles and radical excision on one side or performance status, tolerability of treatment, and actual life expectancy on the other. HCC patients are not only in need for specific treatments, they must also be guided through routine activities in order to ameliorate their own hepatopathic condition, such as lifestyle correction (diet, water and salt assumption, physical activity, and smoking); instructions to the patient himself and to his family for therapeutical adhesion and instruction for early recognition of

Physiological age is a new fundamental concept which is crucial in evaluating an advance in aged patient's performance status beyond his chronological age, which is still today too often used as a threshold to exclude or include a patient into specific treatment protocols [4].

The aim of this chapter is to give guidelines about management of elderly patients suffering from HCC and to give indications to treat those suffering from HCC as primary malignancy,

[1]. Diagnosis and treatment of HCC always require multidisciplinary approaches.

to choose the one that allows the best risk-benefit ratio for a chosen patient.

management experience, thus to avoid iatrogenic prognosis worsening.
