The Expert Group for Liver Diseases

The suggestions for prevention, screening, diagnosis and treatment

of hepatocellular carcinoma

The problem of HCC should be pointed out in order to work on the HCC incidence and mortality epidemiologically on the territory of the Republic of Serbia, turning attention to every region. The neseccity of these data is connected with the intention of making further decisions in the frame of the HCC screening plans. The performer is the Republic Health Protection Institute, Belgrade; Serbian Institute of Oncology and Radiology, Belgrade; The Institute of Oncology, Sremska Kamenica.

HCC Prevention: In the frame of this problem the work should be done in four directions. Firstly: the vaccination of the endangered population. Secondly: to create the program in order to struggle against alcohol addiction which decreases the number of liver cirrhosis. Thirdly: to treat the patients with chronic viral infecions. The other expert groups will solve this problem at their concensus conferencies.The fourth problem is cancerous aflatoksin which can be found in the grains imported from the tropics ( peanuts and others). It should be prevented by a rigorous control of the Food Inspection Sevice at the Customs. The Expert Group for liver diseases is going to solve the first problem. The second problem will be solved by the Republic Health Protection Institute, Belgrade. The Ministry of Health is responsible for the third problem.

HCC Screening: The HCCscreening should be performed in the endangered population, the population with more risk factors of HCC. We consider that the Serbian and Montenegrian Association of Gastroenterologists and Hepathological Department of the Serbian Doctors’ Society should carry out the concensus of HCC screening. This Concensus must be proclaimed as an obligatory one by the Serbian Ministry of Health.

HCC Diagnosis and Treatment: The diagnosis and treatment of HCC should be put into effect under the Minimal Recommendations for diagnosis and treatment of HCC which had been adopted by the Concensus of The Serbian and Montenegrian Association of Gastroenterologists and Hepathological Department of the Serbian Doctors’ Society. The Concensus would consist of the minimum of diagnosis and treatment of HCC which must be carried out in the Republic of Serbia. Of course, there no restrictions for the Institutions which have the possibilities to work exceeding this minimum. This Concensus, regulated by the Serbian Ministry of Health,would be obligatory for all intitutions.

Predlog za prevenciju, skrinig, dijagnostiku i lečenje hepatocelularnog karcinoma

Ukazivanje na problem HCC – epidemiološki obraditi incidenciju i mortalitet HCC na teritoriji Republike Srbije, sa posebnim osvrtom na svaki od regiona. Ovi podaci su potrebni radi daljih odluka u okviru planiranja skrininga HCC. Izvršioci su Republički zavoda za zaštitu zdravlja, Beograd, Institut za onkologiju i radiologiju Srbije, Beograd, Instituta za onkologiju Sremska Kamenica.

Prevencija HCC – u okviru ovog problema potrebno je delatnost usmeriti u šetiri pravca – prvo, vakcinisanje ugrožene populacije, i drugo zajedno sa specijalistima socijalne medicine uraditi program borbe protiv alkoholizma kojim bi se smanjio broj ciroza jetre. Treći problem je lečenje bolesnika sa hroničnim virusnim infekcijama, ovaj problem će se rešavati od strane drugih ekspertskih grupa i njihovih konseknzus konferencija. Četvrti problem je karcinogen aflatoksin koji se nalazi u zrnevlju uvezenom iz tropa (kikiriki i drugo zrnevlje) što bi trebalo sprečiti rigoroznim kontrolama od strane Sanitarne inspekije na samoj granici prilikom uvoza. Izvršioci su za prvi problem Ekspertska grupa za bolesti jetre, za drugi Republički zavod za zaštitu zdravlja, Beograd, a za treći Ministarstvo zdravlja.

Skrining HCC – bi se sprovodio samo kod populacije sa povišenim rizikom za nastanak HCC. Predlažemo da se od strane Udruženja Gastroenterologa Srbije i Crne Gore i Hepatološke sekcije SLD donese konsenzus o skriningu HHC. Ovaj konsenzus bi Ministarstvo zdravlja Republike Srbije moralo da proglasi obavezujućim.

Dijagnostika i lečenje HCC – bi se sprovodilo pod okriljem Minimalnih preporuka za dijagnostiku i lečenje HCC koje bi bile donete konsenzusom od strane Udruženja Gastroenterologa Srbije i Crne Gore i Hepatološke sekcije Srpskog Lekarskog Društva. U njemu bi bili minimumi dijagnostike i lečenja HCC koji bi se morali sprovoditi u Republici Srbiji, naravno oni ne ograničavaju ustanove koje mogu da rade iznad ovog minimuma. Ovaj konsenzus bi takođe bio obavezujući za sve, propisan od strane Ministarstva zdravlja Republike Srbije.