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Review
. 2015 Nov 14;21(42):12003-21.
doi: 10.3748/wjg.v21.i42.12003.

Diagnostic and therapeutic management of hepatocellular carcinoma

Francesco Bellissimo  1 , Marilia Rita Pinzone  1 , Bruno Cacopardo  1 , Giuseppe Nunnari  1
Affiliations
Review

Diagnostic and therapeutic management of hepatocellular carcinoma

Francesco Bellissimo et al. World J Gastroenterol. .

Abstract

Hepatocellular carcinoma (HCC) is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines.

Keywords: Cancer; Chronic hepatitis; Cirrhosis; Hepatitis B virus; Hepatitis C virus; Hepatocellular carcinoma; Liver.

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Figures

Figure 1
Figure 1
American Association for the Study of Liver Diseases diagnostic algorithm for suspected hepatocellular carcinoma (adapted from[7]). CT: Computed tomography; MDCT: Multidetector CT; MRI: Magnetic resonance imaging; US: Ultrasound; HCC: Hepatocellular carcinoma.
Figure 2
Figure 2
Barcelona Clinic Liver Cancer staging system and treatment strategy for hepatocellular carcinoma (adapted from Ref. [49]). M: Metastasis classification; N: Node classification; PS: Performance status; RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization.
See this image and copyright information in PMC

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