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Abstract Hepatocellular carcinoma is ranked as the fifth leading cause of cancer and the third leading cause of cancer death throughout the world. (Yu et al., 2000), (Parkin et al., 2005) and (Bosch et al., 2005) HCC accounts for approximately 85% to 90% of all primary liver cancers with a median survival of less than one year, out of which 80% of HCC cases occur in either sub- Saharan Africa or in eastern Asia. (El-Serag and Rudolph, 2007) HCC is the fifth most common cancer among men worldwide, but is the eighth in women. (Parkin et al., 2005) and (Parkin, 2006) Geographical variations in HCC incidence and mortality can be ascribed to different levels of exposure to HCC risk factors where chronic infections with hepatitis B virus, hepatitis C virus and aflatoxin exposure in developing countries, and smoking and alcohol abuse in developed countries. (Okuda, 1997) Hepatocarcinogenesis is a multi-factor, multi-step and complex process. (Yu and Keeffe 2003) Obviously, four major (more than 80% of HCC occurs in hepatitis virus related cirrhosis and chronic viral hepatitis (Bosch, 1997) and several minor causal associations of HCC have been identified. (Kew, 1981) Diagnostic confirmation and assessment of HCC extent are crucial for proper clinical management which is based on imaging characteristics in combination with clinical and laboratory findings, a biopsy is not required pre-surgery, but is required before the start of systemic therapy. (Lencioni et al., 2005) and (Asmis et al., 2010) There are multiple applications of Intraoperative ultrasonography including: 1. Re-evaluation of the tumor and detection of new Tumor lesions. 2. Evaluation of intrahepatic vasculature. 3. Guidance for Hepatic Resection. 4. Guidance of intraoperative radiofrequency ablation and other ablative techniques. 5. Laparoscopic techniques. (Arita et al., 2009) 82 Summary & Conclusions We concluded: Hepatocellular carcinoma was more common in male than women approximately 3:1 and all of the studied patients were cirrhotic due to HCV infection except two patients are cryptogenic in origin. There was no positive family history illustrating no hereditary factors is related to etiology of HCC. Using of AFP and abdominal ultrasound and triphasic CT are not enough for diagnosis of HCC. We need adding another modality for better detection of HCC such as Multidetector CT, Magnetic Resonance Imaging (MRI) or contrasted enhanced ultrasonography (CEUS). Using of intraoperative ultrasonography was cornerstone modality for any hepatic surgery because its accuracy in detecting lesions especially on inferior and diaphragmatic surfaces and detection of new malignant lesions here, we had to take a core biopsy especially for doubtful lesions less than 2cm in diameter, |