title: The diagnosis and treatment of hepatocellular carcinoma.
abstract: BACKGROUND
  The incidence of hepatocellular carcinoma (HCC) has continued to rise in recent years. This increase has been attributed to alcohol-induced liverdiseases, metabolic syndrome, and the rising number of hepatitis B and C viral infections.
  
  
  METHODS
  Pertinent publications (2000-2011) were retrieved by a systematic Medline search. In seven different subject areas, 41 key questions were defined; 15 of them were answered on the basis of a primary search. In addition, original-source guidelines that are currently available from around the world were assessed and utilized with the aid of a systematic instrument for the evaluation of guidelines (DELBI).
  
  
  RESULTS
  All patients with chronic liver disease should undergo ultrasonography every six months for the early detection of HCC. Measurement of the alphafetoprotein (AFP) concentration is not obligatory, as this test is relatively insensitive when used for early detection. If ultrasonography reveals a mass, a tomographic imaging study with contrast should be obtained; the latter may reveal a characteristic pattern of contrast enhancement that can be accepted as definitive evidence of HCC. Fine-needle biopsy has a sensitivity and specificity of over 90% for the diagnosis of HCC. Any patient in whom HCC has been diagnosed should be referred to a center where potentially curative treatments (surgery, transplantation, local ablation) can be considered. Radiofrequency ablation (RFA) is now performed instead of percutaneous ethanol instillation. For patients with advanced tumors, sorafenib should only be offered to those in Child-Pugh stage A. This drug has been found to prolong mean overall survival from 7.9 to 10.7 months.
  
  
  CONCLUSIONS
  HCC poses particular diagnostic and therapeutic challenges that are best met with an interdisciplinary management approach.
authors.affiliation: Department of Medicine, Eberhard Karls University of Tübingen, Department of Gastroenterology, Hepatology and Endocrinology, Hanover Medical School, Center for Cancer Research, NIH, Bethesda, USA.
authors.forename: Nisar P
authors.initials: NP
authors.lastname: Malek
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schmidt
authors.forename: Petra
authors.initials: P
authors.lastname: Huber
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Tim F
authors.initials: TF
authors.lastname: Greten
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D038622:Internationality; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008495:Medical Oncology / Q000592:standards*; D017410:Practice Guidelines as Topic