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Review
. 2017 Aug 7;23(29):5282-5294.
doi: 10.3748/wjg.v23.i29.5282.

From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world

Dimitrios Dimitroulis  1 , Christos Damaskos  1 , Serena Valsami  1 , Spyridon Davakis  1 , Nikolaos Garmpis  1 , Eleftherios Spartalis  1 , Antonios Athanasiou  1 , Demetrios Moris  1 , Stratigoula Sakellariou  1 , Stylianos Kykalos  1 , Gerasimos Tsourouflis  1 , Anna Garmpi  1 , Ioanna Delladetsima  1 , Konstantinos Kontzoglou  1 , Gregory Kouraklis  1
Affiliations
Review

From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world

Dimitrios Dimitroulis et al. World J Gastroenterol. .

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as hepatitis B virus or chronic hepatitis C virus, nonalcoholic fatty liver disease, consumption of aflatoxins and tobacco smocking. Clinical presentation varies widely; patients can be asymptomatic while symptomatology extends from right upper abdominal quadrant paint and weight loss to obstructive jaundice and lethargy. Imaging is the first key and one of the most important aspects at all stages of diagnosis, therapy and follow-up of patients with HCC. The Barcelona Clinic Liver Cancer Staging System remains the most widely classification system used for HCC management guidelines. Up until now, HCC remains a challenge to early diagnose, and treat effectively; treating management is focused on hepatic resection, orthotopic liver transplantation, ablative therapies, chemoembolization and systemic therapies with cytotocix drugs, and targeted agents. This review article describes the current evidence on epidemiology, symptomatology, diagnosis and treatment of hepatocellular carcinoma.

Keywords: Cancer; Diagnosis; Epidemiology; Hepatocellular; Staging; Transplantation; Treatment.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Imaging studies used in diagnosis, treatment planning, management and follow-up of hepatocellular carcinoma.
Figure 2
Figure 2
Multiphasic computed tomography in a large hepatocellular carcinoma located in the right liver lobe. A: Unenhanced image; B: Lesion’s enhancement in the late hepatic arterial phase; C: Lesion’s “washout” in the portal venous phase; D: Delayed phase image. The lesion has capsule appearance most shown in the portal venous and delayed phase.
Figure 3
Figure 3
Well differentiated, (grade 1) hepatocellular carcinoma and early hepatocellular carcinoma with diffuse fatty change. A: White arrows indicate the interface between HCC (left) and background liver (right); B: HCC cells show high nuclear/cytoplasmic ratio and minimal nuclear atypia. A: H/E × 100, B: H/E × 200; C and D: Early HCC with diffuse fatty change. Black arrowhead depicts a preserved portal tract. Gomori stain shows rarefaction of reticulin network. C: H/E × 100, D: Gomori stain × 100. HCC: Hepatocellular carcinoma.
Figure 4
Figure 4
Combined hepatocellular-cholangiocarcinoma with stem cell features, intermediate cell subtype. Tumor expresses both hepatocellular (HepPar1) and biliary (CK19) immunohistochemical markers. A: H/E × 100; B: HepPar1 × 100; C: CK19 × 100.
Figure 5
Figure 5
Intra-operative situs [prior (A) and post (B) right hepatectomy] and surgical specimen (C) of a large hepatocellular carcinoma located in the right liver lobe.
See this image and copyright information in PMC

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