Malignant Liver Tumours Basic Concepts And Clinical Management

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC), both increasing in incidence, have become a major topic of basic and clinical research as well as clinical practice in hepatology. Experts in the field update the current concepts on the carcinogenesis of HCC and CC such as genetic alterations in the pathways of cell cylce and apoptosis regulation, the hypothesis of dedifferentiation of hepatocytes to the malignant phenotype vs that of activation of hepatic progenitor cells incapable of maturation (maturation arrest hypothesis). In spite of an increasing number of genetic alterations described in human HCC as well as cell regulatory pathways tested in experimental HCC models, the key hits causing progression of the cell cycle in imbalance with apoptosis, tissue invasive growth and metastatic potential of cell clones still remain elusive. Very powerful genomic and proteomic techniques are promising insights into the carcinogenesis of liver malignancies that will allow more efficient therapeutic strategies. The current concepts on risk profiling, surveillance of risk groups and therapeutic strategies are evidence-based for HCC and less detailed for CC. Surveillance of risk groups improves detection of liver tumours in curable stages. Best strategies for curative treatment of HCC use neoadjuvant antitumour therapies before liver transplantation and a role is emerging for living donor-related liver transplantation. New palliative therapies for HCC are in the experimental stage with biological response modifiers, including angiogenesis inhibitors, and entering phase II clinical trials with the alpha-fetoprotein derived vaccines.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC), both increasing in incidence, have become a major topic of basic and clinical research as well as clinical practice in hepatology. Experts in the field update the current concepts on the carcinogenesis of HCC and CC such as genetic alterations in the pathways of cell cylce and apoptosis regulation, the hypothesis of dedifferentiation of hepatocytes to the malignant phenotype vs that of activation of hepatic progenitor cells incapable of maturation (maturation arrest hypothesis). In spite of an increasing number of genetic alterations described in human HCC as well as cell regulatory pathways tested in experimental HCC models, the key hits causing progression of the cell cycle in imbalance with apoptosis, tissue invasive growth and metastatic potential of cell clones still remain elusive. Very powerful genomic and proteomic techniques are promising insights into the carcinogenesis of liver malignancies that will allow more efficient therapeutic strategies. The current concepts on risk profiling, surveillance of risk groups and therapeutic strategies are evidence-based for HCC and less detailed for CC. Surveillance of risk groups improves detection of liver tumours in curable stages. Best strategies for curative treatment of HCC use neoadjuvant antitumour therapies before liver transplantation and a role is emerging for living donor-related liver transplantation. New palliative therapies for HCC are in the experimental stage with biological response modifiers, including angiogenesis inhibitors, and entering phase II clinical trials with the alpha-fetoprotein derived vaccines.

The translation of new molecular understanding of disease into clinical practice in gastroenterology is a special challenge. The Falk Symposium No. 160, entitled ‘Pathogenesis and Clinical Practice in Gastroenterology’, held 15-16 June 2007 in Portorož, Slovenia, provided a stimulating framework to bridge discussions from bench to bedside. The proceedings of the symposium are contained in this book, and the unifying theme is the growing understanding of inflammation as a driving force in chronic disease leading to disability and malignancy. Aspects of early detection - endoscopically or via molecular markers - are covered as well as in-depth discussions of the validation of new findings in clinical practice. Whilst on a molecular basis gastroenterologists and hepatologists try to shed light on the same intracellular pathways, clinical implications such as surveillance of cancer in IBD or chronic hepatitis with cirrhosis have to be tailored to specific needs. New therapeutic agents - approved or on the horizon of early clinical studies - will dramatically change the options of patients with chronic disease such as Crohn’s disease, viral hepatitis or hepatocellular carcinoma.

This book, the proceedings of Falk Symposium 124, `Medical Imaging in Gastroenterology and Hepatology' (Progress in Gastroenterology and Hepatology Part I), held in Hannover, Germany, on September 28-29, 2001, aims to demonstrate the newest developments in the various imaging techniques for diagnosis and therapy, coupled with overviews by renowned international experts. In this book, up-to-date technologies in medical imaging and image documentation as well as the most modern transmission techniques should bridge the gap between futuristic research and everyday clinical practice.

Autoimmune processes in the liver can cause severe damage and destruction leading to cirrhosis and liver failure. The clinical spectrum of autoimmune liver disease is very wide, and diagnostic difficulties often stand at the beginning of the patient’s medical career. While in autoimmune hepatitis immunosuppressive therapy has long been shown to be life-saving, therapeutic progress is small in primary biliary cirrhosis and questionable in primary sclerosing cholangitis. New approaches to treatment will be needed in the future, but require better understanding of the pathogenesis of the underlying disease process. This book, the proceedings of Falk Symposium 142 on 'Autoimmune Liver Disease’ held in Freiburg, Germany, on 12–13 October 2004 (Part I of the Gastroenterology Week Freiburg), describes possible mechanisms of pathogenesis, discusses diagnostic criteria and takes up controversies concerning treatment options. In view of the relatively frequent manifestation of autoimmune hepatitis in childhood in particular, paediatric aspects of autoimmune liver disease, and the role of liver transplantation, are given prominence.

In 1996, an international symposium entitled "Future Perspectives in Gastroenterology" was held in the city of Leipzig, State of Saxony, Germany. Leading scientists in diverse fields of gastroenterology presented their recent findings and undertook the propitious risk of speculating about future directions. Thanks once again to the generous support of the Falk Foundation, it was possible to revisit a symposium with the same title, but held this time in the beautiful, rebuilt city of Dresden in Saxony. This book contains the proceedings of the Falk Symposium No. 161 on "Future Perspectives in Gastroenterology", held October 11–12, 2007. It presents many innovative themes as well as "new faces" and offers a rich opportunity to learn firsthand about the latest scientific discoveries in the broad field of gastroenterology. Several of these novel developments are probably well on their way to being implemented in clinical practice.

This book, the proceedings of a Falk Workshop on `Topical Steroids in Gastroenterology and Hepatology', held in Berlin, Germany, on 14 June 2003, critically discusses the current role of budesonide in gastroenterology, hepatology, surgery and oncology and focuses especially on potential new indications for the use of budesonide. A number of smaller clinical studies and anecdotal case reports with impressive clinical effects are reported in patients with gastrointestinal, hepatic, oncological and surgical problems. In addition, the use of budesonide for the treatment of distal ulcerative colitis and ileocolonic Crohn's disease is evaluated with respect to its role in an evidence-based management of IBD. Finally, as clinical experience with the use of budesonide is increasing, safety issues and the side-effect profile of budesonide is addressed.

This book is the proceedings of the 18th International Bile Acid Meeting, held as the Falk Symposium 141 in Stockholm, Sweden, on June 18–19, 2004. The International Bile Acid Meetings have become some of the most important meetings in the bile acid field worldwide since Herbert Falk decided to sponsor these Symposia in biannual sequence in 1970. The 17 International Bile Acid Meetings in the past have been a great stimulus for new ideas and methods as well as the development of therapeutic applications of bile acids. They have always been a forum where basic scientists and clinicians interact. Many novel results of bile acid research were first presented at these meetings. The meeting in Stockholm again attracted a large number of basic and clinical scientists interested in bile acid and biliary research from all over the world. Knowledge about the regulation of bile acid synthesis, bile acid transport and enterohepatic circulation in health and in disease has increased considerably during recent years. Accordingly, bile acid research is alive as ever. A new chapter of bile acid research was opened by the finding that bile acids are ligands of nuclear receptors which regulate synthesis, metabolism and transport of bile acids and steroids. A large part of the book is devoted to these topics. The 18th International Bile Acid Meeting was again a truly interdisciplinary symposium at the highest scientific level. Its participants enjoyed hearing the latest reports on bile acid research in the city where so many seminal studies on bile acids were performed. It is hoped that the readers of this book will share the enjoyment.