Review article: the management of hepatocellular carcinoma.
BACKGROUND
Hepatocellular carcinoma is the leading cause of death in cirrhosis. A majority of patients present at an advanced stage with poor prognosis.


OBJECTIVE
To review the current screening, diagnosis and management strategies involved in hepatocellular carcinoma.


METHODS
A literature search was performed using PubMed for publications with a predetermined search string to identify relevant studies.


RESULTS
Hepatocellular carcinoma is dramatically increasing in incidence that is mostly attributed to chronic hepatitis C and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and its clinical phenotype diabetes and obesity. Cirrhosis is the major predisposing risk factor and its presence necessitates close surveillance for hepatocellular carcinoma with serial imaging studies. Hepatocellular carcinoma can be diagnosed by its unique radiological behaviour of arterial enhancement and washout on delayed images. The Barcelona Clinic Liver Cancer staging classification system is a clinically useful algorithm for the management of patients with hepatocellular carcinoma. The simultaneous presence of cirrhosis in the patients complicates their management and monitoring for cirrhosis-related complications is important.


CONCLUSIONS
Early diagnosis and definitive treatment remains the key to long-term outcome. A multidisciplinary approach is critical to the successful management of hepatocellular carcinoma. Studies combining sorafenib with locoregional or other targeted molecular therapies are likely to improve responses and outcome.
Cabrera
R
R
Section of Hepatobiliary Diseases, Division of Gastroenterology, Hepatology and Nutrition, Department Of Medicine, University of Florida, Gainesville, FL 32610-0277, USA. cabrer@medicine.ufl.edu
Nelson
D R
DR
D055011:Ablation Techniques; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D044466:Asian People; D001557:Benzenesulfonates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001706:Biopsy; D044383:Black People; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D003875:Drug Eruptions / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011725:Pyridines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D000077157:Sorafenib; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D001741:Black or African American
D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D003287:Contrast Media; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib