Hepatocellular Carcinoma: Current Concepts in Diagnosis, Staging and Treatment

Abstract

Background: Hepatocellular carcinoma (HCC) significantly contributes to the global burden of cancer. Liver cancer is the third most frequent cause of cancer-related death, with HCC representing more than 90% of primary liver cancers. During the last decade, much progress has been made with respect to the definition of patient populations at risk who may benefit from surveillance strategies, as well as in the diagnosis and treatment of the disease. Summary: New locoregional and systemic therapies have significantly increased the survival of patients with HCC. A multitude of clinical trials addressing patients with HCC have led to advancements in the allocation of subgroups of patients to their optimal individual treatment strategy. This review provides an overview on recent developments in diagnostic and therapeutic modalities and an outlook on future directions in the management of HCC. Key Message: New locoregional and systemic therapies in patients with HCC have significantly improved clinical outlook and patient survival. This review provides an overview of recent developments in diagnostics and therapeutics, as well as an outlook on future directions in the management of HCC. Practical Implications: Transabdominal ultrasound is the method of choice for the surveillance of patients at risk of developing HCC, and any suspicious focal lesion in the liver should be characterized. Contrast-enhanced ultrasound with application of second-generation contrast agents enables visualization of tumor vascularity. The Barcelona Clinic Liver Cancer (BCLC) system is the most widely used classification system to guide the clinical management of HCC. Liver resection should be considered for patients with well-preserved liver function and without portal hypertension or elevated bilirubin. Patients not suitable for resection should undergo local tumor ablation. Candidates who are eligible for liver transplantation may benefit from bridging therapy during their waiting period. Patients in the BCLC B category benefit from locoregional transarterial therapy; transarterial chemoembolization is the treatment of choice. Sorafenib is the only systemic therapy that has been shown to prolong overall survival in patients with advanced disease, and is therefore recommended in patients with well-preserved liver function.

A novel microRNAs expression signature for hepatocellular carcinoma diagnosis and prognosis

“…Thus its specificity is not satisfying. The European Association for the Study of Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) guidelines do not even recommend AFP as a diadynamic criteria of hepatocellular carcinoma [ 5 ]. The AASLD and EASL guidelines only consider the results made from four-phase computed tomography (CT) and dynamic-contrast magnetic resonance (MR), while the Asian Pacific Association for the Study of the Liver (APASL) concerns the size of the lesion [ 6 ].…”

Metallothionein 1H (MT1H) functions as a tumor suppressor in hepatocellular carcinoma through regulating Wnt/β-catenin signaling pathway

“…Hepatocellular cancer (HCC), the third cause of cancer-related death worldwide, accounts for 85%-90% of all primary liver cancer [ 1 , 2 ]. In China, it is the most commonly diagnosed cancer and the leading cause of cancer death in male patients younger than 60 years old [ 3 ].…”

Evaluation of hepatic steatosis before liver transplantation in ex vivo by volumetric quantitative PDFF‐MRI

“…Liver transplantation is currently the only curative therapy for end‐stage liver disease, early‐stage hepatocellular carcinoma, and cirrhosis 1‐3 . For patients with these diseases, liver transplantation is the single most effective approach to improve patient survival.…”