Current management of hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Despite efforts for prevention and screening as well as development of new technologies for diagnosis and treatment, the incidence of HCC has doubled, and mortality rates have increased in recent decades. A variety of important risk factors are associated with the development of HCC, with any type of cirrhosis, regardless of etiology, being the major contributor. Hepatitis C virus infection with bridging fibrosis or cirrhosis and hepatitis B virus infection are independent risk factors. The diagnosis of HCC is made without liver biopsy in over 90% of cases. Screening with ultrasound and alpha-fetoprotein (AFP) at 6-month intervals is advised; however, it is not adequate for patients on the orthotopic liver transplantation (OLT) list. Triple-phase computed tomography and/or magnetic resonance imaging are used in combination with the detection of AFP, AFP-L3%, and/or des-gamma-carboxy prothrombin due to their superior sensitivities and specificities. Several treatment modalities are available, but only surgical resection and OLT are curative. OLT is available only for patients who meet or are downstaged into Milan or University of California, San Francisco criteria. Other treatment options include radiofrequency ablation, microwave ablation, percutaneous ethanol injection, transarterial chemoembolization, radioembolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, and molecularly targeted therapies. The management of HCC is based on tumor size and location, extrahepatic spread, and underlying liver function. Given the complexity of the disease, patients are often best served in centers with experience in HCC management, where a multi-disciplinary approach can take place.
Dr Crissien is a gastroenterology and hepatology fellow in the Division of Gastroenterology of the Department of Medicine at Scripps Green Hospital in La Jolla, California. Dr Frenette is the medical director of liver transplantation at the Scripps Center for Organ and Cell Transplantation at Scripps Green Hospital.
Ana Maria
AM
Crissien
Dr Crissien is a gastroenterology and hepatology fellow in the Division of Gastroenterology of the Department of Medicine at Scripps Green Hospital in La Jolla, California. Dr Frenette is the medical director of liver transplantation at the Scripps Center for Organ and Cell Transplantation at Scripps Green Hospital.
Catherine
C
Frenette
Hepatocellular carcinoma; hepatoma; liver transplantation; radiofrequency ablation; sorafenib; transarterial chemoembolization