title: Management of small hepatocellular carcinoma in cirrhosis: focus on portal hypertension.
abstract: The incidence of hepatocellular carcinoma (HCC) is rising worldwide being currently the fifth most common cancer and third cause of cancer-related mortality. Early detection of HCC through surveillance programs have enabled the identification of small nodules with higher frequency, and nowadays account for 10%-15% of patients diagnosed in the West and almost 30% in Japan. Patients with small HCC can be candidates for potential curative treatments: liver transplantation, surgical resection and percutaneous ablation, depending on the presence of portal hypertension and co-morbidities. This review will analyze recent advancements in the clinical management of these individuals, focusing on issues related to the role of portal hypertension, the debate between resection and ablative therapies and the future impact of molecular technologies.
authors.affiliation: Hepatocellular Carcinoma Translational Research Laboratory, Barcelona-Clinic Liver Cancer Group, Institut d'Investigacions Biomediques August Pi i Sunyer, Liver Unit, Hospital Clinic, 08036 Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernandez-Gea
authors.forename: Fanny
authors.initials: F
authors.lastname: Turon
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Augusto
authors.initials: A
authors.lastname: Villanueva
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000818:Animals; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D000431:Ethanol / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000431:Ethanol
keywords: Clinically significant portal hypertension; Hepatic venous pressure gradient; Hepatocellular carcinoma; Liver cancer; Liver stiffness; Percutaneous ethanol injection; Portal hypertension; Radiofrequency ablation; Resection