Review: Current status of therapy for hepatocellular carcinoma

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multidisciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient's overall functional status. Curative therapies include surgical resection, liver transplantation (LT), transarterial chemoembolization, and radiofrequency ablation (RFA). Surgical resection, either primary resection or LT, is the treatment most likely to result in cure of HCC. Which option to pursue is based on multiple factors. LT has the potential benefit of treating both HCC and the underlying cirrhosis; however, long wait times incur the risk of tumor progression. Firm recommendations regarding the role of living donor LT for HCC are not yet possible because of conflicting data. HCC recurrence after LT is 8-11% and several adjuvant therapies have been investigated to reduce this. Bridging therapy and tumor downsizing are techniques that also may be considered to deal with long waiting periods and qualification for LT, respectively. If neither LT nor primary resection is possible, locoregional therapies such as RFA and TACE should be considered. Systemic chemotherapies have proved disappointing for the treatment of HCC; however, newer targeted therapies such as sorafenib and cetuximab have provided new hope for the future.

Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden

“…Curative treatments for HCC include resection, ablation, and liver transplantation. However, only 20% of patients with HCC have sufficiently preserved liver function to undergo resection . Therefore, liver transplantation is often the treatment of choice to cure both HCC and the underlying liver disease.…”

Non-ionic iodinated contrast-induced sialadenitis with parotid gland sparing in patient of hepatocellular carcinoma

“…Management plan for the patient included radiofrequency ablation (RFA) in perception for small tumour size and unifocal disease process 3. At our institution, the first triphasic CECT scan was carried out 6 weeks following RFA to assess the treatment response and to rule out residual or recurrent disease process.…”

Emerging Trends in Oncology: Greater Role for Radiology

“…Taking hepatocellular carcinoma as an example, interventional ablative procedures used to be reserved for patients deemed unsuitable for curative surgical resection, or for patients with disease recurrence [1]. However, percutaneous ablation of tumours is today recognized as potentially curative therapy for early hepatocellular carcinoma [2,3].…”