title: New advances in hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) is the leading cause of deaths in cirrhotic patients and the third cause of cancer related deaths. Most HCC are associated with well known underlying risk factors, in fact, HCC arise in cirrhotic patients in up to 90% of cases, mainly due to chronic viral hepatitis and alcohol abuse. The worldwide prevention strategies are conducted to avoid the infection of new subjects and to minimize the risk of liver disease progression in infected patients. HCC is a condition which lends itself to surveillance as at-risk individuals can readily be identified. The American and European guidelines recommended implementation of surveillance programs with ultrasound every six months in patient at-risk for developing HCC. The diagnosis of HCC can be based on non-invasive criteria (only in cirrhotic patient) or pathology. Accurately staging patients is essential to oncology practice. The ideal tumour staging system in HCC needs to account for both tumour characteristics and liver function. Treatment allocation is based on several factors: Liver function, size and number of tumours, macrovascular invasion or extrahepatic spread. The recommendations in terms of selection for different treatment strategies must be based on evidence-based data. Resection, liver transplant and interventional radiology treatment are mainstays of HCC therapy and achieve the best outcomes in well-selected candidates. Chemoembolization is the most widely used treatment for unresectable HCC or progression after curative treatment. Finally, in patients with advanced HCC with preserved liver function, sorafenib is the only approved systemic drug that has demonstrated a survival benefit and is the standard of care in this group of patients.
authors.affiliation: Sonia Pascual, Iván Herrera, Javier Irurzun, Liver Unit, Gastroenterology Department, Interventional Radiological Unit, Hospital General Universitario de Alicante, 03010 Alicante, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pascual
authors.affiliation: Sonia Pascual, Iván Herrera, Javier Irurzun, Liver Unit, Gastroenterology Department, Interventional Radiological Unit, Hospital General Universitario de Alicante, 03010 Alicante, Spain.
authors.forename: Iván
authors.initials: I
authors.lastname: Herrera
authors.affiliation: Sonia Pascual, Iván Herrera, Javier Irurzun, Liver Unit, Gastroenterology Department, Interventional Radiological Unit, Hospital General Universitario de Alicante, 03010 Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Irurzun
keywords: Hepatocellular carcinoma; Liver surgery; Liver transplant; Radiofrequency ablation; Staging system; Surveillance; Transarterial chemoembolization