Diagnostics and Treatment of Hepatocellular Carcinoma in 2016: Standards and Developments

Abstract

Background: Hepatocellular carcinoma (HCC) is a frequent complication of liver cirrhosis. Worldwide, HCC is one of the most common cancers, with a rising incidence.

Methods: A selective literature search was conducted, taking into account current studies, reviews, meta-analyses, and guidelines.

Results: The diagnosis is established either non-invasively by dynamic imaging, showing a typical contrast enhancement and wash-out, or histopathologically. Pathological diagnosis of HCC is recommended for all atypical nodules in patients with cirrhosis and for those in non-cirrhotic patients. Tumor therapy as well as treatment of the underlying chronic liver disease and/or preservation of liver function are important for the management of patients with HCC. Standard stage-adapted treatments are based on the widely applied Barcelona Clinic Liver Cancer staging system including liver resection and transplantation, interventional treatments such as thermal ablation and transarterial therapies, and systemic treatment with the tyrosine kinase inhibitor sorafenib. After failure of sorafenib, anti-angiogenic drugs, MET inhibitors, and immunotherapeutics are currently under advanced clinical investigation.

Conclusion: Treatment of HCC is multidisciplinary and therefore requires a close cooperation between various disciplines such as hepatology, visceral surgery, radiology, and oncology to achieve the best outcome depending on the tumor stage and degree of liver function impairment.

Keywords: Hepatocellular carcinoma; Interventional treatment; Liver cirrhosis; Resection; Systemic therapy; Transplantation.

Fig. 1

Annual incidence rates of liver cancer in Germany from 1999 till 2012 for men (blue) and females (red). The numbers given indicate the estimated annual number of patients with newly diagnosed primary liver cancer (ICD-10 code C22) (Zentrum für Krebsregisterdaten im Robert Koch-Institut, www.krebsdaten.de; accessed 10.01.2016).

Fig. 2

Modified Barcelona Clinic Liver Cancer (BCLC) staging system. HCC is categorized as early- (BCLC 0 and BCLC A), intermediate- (BCLC B), advanced- (BCLC C), or end-stage (BCLC D) [4]. RFA = Radiofrequency ablation; TACE = transarterial chemoembolization; SIRT = selective intra-arterial radioembolization; BSC = best supportive care.

Fig. 3

MRI of a patient with a HCC with a typical contrast uptake in the arterial phase and b wash-out in the venous phase. Arrowheads indicate the tumor location.