Cirrhosis is a process in which liver cells are damaged or killed and replaced with scar tissue. Extensive scar tissue formation impairs the flow of blood through the liver, causing more liver cell death and a loss of liver function. Decompensated cirrhosis is when the scarring of the liver is so extensive that the liver can no longer compensate for the damage. The liver, at this stage, will be covered with nodules and shrunken in size and begins to be unable to carry out its essential functions. Once decompensated cirrhosis is established serious complications are almost inevitable and there is usually a very high frequency of readmissions to hospital.
Until recently it was generally thought that treating people with HCV-induced decompensated cirrhosis with pegylated interferon was not worthwhile as the response rates tended to be low, the risks of severe side effects and the possibility that treatment might accelerate the deterioration of the liver. However, recent studies suggest that treatment may help carefully selected patients with decompensated cirrhosis, who have not previously had treatment and who currently have few options other than liver transplantation. (see treatment for decompensated cirrhosis). It is also hoped that if, as expected, new treatments for HCV infection are available over the next few years this will considerably help people with decompensated cirrhosis with the possibility of shorter periods of treatment and less side effects from the toxicity of the drugs.
There is now considerable expertise in liver transplantation. Survival rates are around seventy per cent after five years. However, the shortage of available donors means that transplants are typically restricted to people whose livers are thought to be in the last year of its life. (see liver transplants)
The overall risk of developing liver cancer or hepatocellular carcinoma (HCC) for people infected with HCV is relatively small. It usually develops decades after infection and is almost exclusively confined to people who have already progressed to cirrhosis. There are no exact figures for the chances that people with HCV will develop liver cancer. However, it seems that around 6% of people who have been infected with HCV for over twenty years will develop HCC.
Once liver cancer does develop the survival rates are very low. It is unlikely that someone with liver cancer will survive for more than five years. The only options are surgery to remove the cancer or a liver transplant. Surgery is only possible if the cancer has not spread beyond the liver. This is why people who have cirrhosis should be screened for liver cancer every six months. Finding a tumour at an early stage significantly increases the chances of recovery. (see liver cancer)
