Current management of patients with hepatocellular carcinoma

Abstract

The current management therapies for hepatocellular carcinoma (HCC) patients are discussed in this review. Despite the development of new therapies, HCC remains a "difficult to treat" cancer because HCC typically occurs in advanced liver disease or hepatic cirrhosis. The progression of multistep and multicentric HCC hampers the prevention of the recurrence of HCC. Many HCC patients are treated with surgical resection and radiofrequency ablation (RFA), although these modalities should be considered in only selected cases with a certain HCC number and size. Although there is a shortage of grafts, liver transplantation has the highest survival rates for HCC. Several modalities are salvage treatments; however, intensive care in combination with other modalities or in combination with surgical resection or RFA might offer a better prognosis. Sorafenib is useful for patients with advanced HCC. In the near future, HCC treatment will include stronger molecular targeted drugs, which will have greater potency and fewer adverse events. Further studies will be ongoing.

Preventive Effects of Vitamin C on Diethylnitrosamine-induced Hepatotoxicity in Smp30 Knockout Mice

“…HCC is one of the most frequently occurring malignancies worldwide and most HCC is complicated due to it occurring typically in patients with advanced hepatic disease (5,6,23). HCC is related to various pathogenic factors such as infection with hepatitis B virus or hepatitis C virus, chronic hepatitis, steatosis (fatty liver), liver cirrhosis and heavy alcohol consumption (4,(24)(25)(26).…”

“…The recognized risk factors for HCC are hepatic disorder associated with steatosis, cirrhosis, viral hepatitis, alcohol, chemical agents, obesity, metabolic syndrome, and so forth (4). Despite recent advances in diagnosis and treatment, the effectiveness of therapy for HCC remains unsatisfactory, and HCC has a hidden development and a poor prognosis (5,6). Therefore, there is an urgent requirement for novel therapeutic compounds for the treatment of patients with HCC.…”

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“…An alternative approach to expanding transplant criteria is downstaging tumors to Milan criteria using TACE, TARE, or percutaneous ablation. 10 …”

“…Other prognostic factors include the alpha-fetoprotein level, differentiation of HCC, number of tumor nodules, portal vein thrombosis, presence of tumor capsule, and degree of lipiodol retention postprocedure. 5,10,15 Drugeluting beads are microspheres that can be loaded with chemotherapeutic agents and used for TACE. Drug-eluting beads produce controlled, sustained release of chemotherapy at decreased peak plasma levels within the systemic circulation ( Figure 3).…”

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“…With advances in surgical resection technique and lower perioperative mortality, survival after liver resection is increasing at many centers. [22][23][24][25][26] This could be particularly important in countries that experience difficulties in obtaining donor livers for transplant. Perhaps the expanded use of resection for HCC and the decreased use of transplant for smaller HCCs could release livers for other transplant indications, such as the presence of a more advanced tumor.…”