SURVEILLANCE

• Many authorities recommend monitoring the fetoprotein level or scheduling a hepatic sonogram every 6 months for patients with cirrhosis, but effectiveness of this strategy is unclear
PROGNOSIS
• Cirrhosis is the most reliable predictor of survival. If there is no cirrhosis at the time of diagnosis, patients have a normal survival with treatment. If cirrhosis is present, 5- and 10-year survivals with treatment are 72% and 62%, respectively [211]
• The risk of developing this cancer is as high as 19% if cirrhosis is present, and 5% if cirrhosis is not present [210]
• Analysis of the causes of death in 69 patients revealed the following findings [212,213]:
1. Hepatocellular carcinoma (HCC) — 19 patients, 119 times more common than in a control population
2. Cirrhosis — 14 patients, 10 times more common
3. Cardiomyopathy — 5 patients, 306 times more common
4. Diabetes mellitus — 4 patients, 14 times more common
• Liver cancers were associated with cirrhosis and the amount of mobilizable iron, but not with the presence of hepatitis B or C markers.

COUNCELLING
• Advise to maintain a diet with only moderate amounts of high-iron-content foods
• Iron supplementation in any form should be strictly avoided.
• There is no reason to discourage vitamin C intake, with the exception of limiting those patients who choose to take supplements to 500 mg/d
• Ethanol should be avoided completely in patients with liver disease
• Patients should be advised to avoid uncooked seafood, because they have a unique susceptibility to Vibrio vulnificus infection.
• Avoid exposure of open wounds to warm coastal seawater.
• Recommend that first-degree relatives (parents, siblings, and children) of people with known hemochromatosis undergo screening.