title: Management of hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC), a common cause for cancer-related death, is increasing worldwide. Over the past decade, survival and quality of life of HCC patients have significantly improved due to better prevention strategies, early diagnosis, and improved treatment options. We performed this narrative review to synthesize current status on the HCC management.
  
  
  METHODS
  Literature search for publications especially over the last decade, which has changed the paradigm on the management of HCC.
  
  
  RESULTS
  Hepatitis B vaccination and treatment of chronic hepatitis B and C are important measures for HCC prevention. Screening and surveillance for HCC using ultrasonogram and alpha-fetoprotein estimation are directed toward cirrhotics and hepatitis B patients at high risk of HCC. If detected at an early stage, curative treatments for HCC can be used such as tumor resection, ablation and liver transplantation. HCC patients without curative options are managed by loco-regional therapies and systemic chemotherapy. Loco-regional treatments include trans-arterial chemoembolization, radioembolization and combinations of loco-regional plus systemic therapies. Currently, sorafenib is the only FDA-approved systemic therapy and newer better chemotherapeutic agents are being investigated. Palliative care for terminally ill patients with metastatic disease and/or poor functional status focusses on comfort care and symptom control.
  
  
  CONCLUSIONS
  In spite of significant advancement in HCC management, its incidence continues to rise. There remains an urgent need to continue refining understanding of HCC and develop strategies to increase utilization of the available preventive measures and curative treatment modalities for HCC.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Fitzmorris
authors.forename: M
authors.initials: M
authors.lastname: Shoreibah
authors.forename: B S
authors.initials: BS
authors.lastname: Anand
authors.forename: A K
authors.initials: AK
authors.lastname: Singal
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D019468:Disease Management; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D008403:Mass Screening / Q000379:methods; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011159:Population Surveillance / Q000379:methods; D011788:Quality of Life; D000077157:Sorafenib; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D010671:Phenylurea Compounds; D014761:Viral Hepatitis Vaccines; D000509:alpha-Fetoproteins; D009536:Niacinamide; D000077157:Sorafenib