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Strategies for the management of hepatocellular carcinoma

Nature Clinical Practice Oncology volume 4, pages 424–432 (2007)Cite this article

Abstract

Hepatocellular carcinoma (HCC) generally develops as a consequence of underlying liver disease, most commonly viral hepatitis. The development of HCC follows an orderly progression from cirrhosis to dysplastic nodules to early cancer development, which can be reliably cured if discovered before the development of vascular invasion (typically occurring at a tumor diameter of approximately 2 cm). The identifiable population at risk makes screening a realistic possibility, and liver imaging is recommended every 6 months for patients with cirrhosis. For patients with preserved liver function and no portal hypertension who develop HCC that is confined to one region of the liver, resection is the preferred treatment. If resection is not possible because of poor liver function, and the HCC is within the Milan criteria (1 nodule ≥5 cm, 2–3 nodules ≥3 cm), liver transplantation is the treatment of choice. To prevent tumor progression while waiting, nonsurgical treatments including percutaneous ethanol injection, radiofrequency ablation, and transarterial chemoembolization are employed, but drop-out from the waiting list remains a problem. Living donor transplantation is an alternative that can eliminate drop-out and enable liver transplantation for patients with HCC whose disease does not fall within the Milan criteria. There is a need for more effective adjuvant therapies after resection and liver transplantation; newer antiangiogenic agents offer hope for improved outcomes in the future.

Key Points

  • If discovered at an early stage, HCC is potentially curable by surgery

  • When localized HCC is discovered in patients with preserved liver function and no portal hypertension, resection is the preferred treatment

  • If resection is not possible (e.g. because of poor liver function) and the HCC is within the Milan criteria, liver transplant is the treatment of choice

  • Nonsurgical treatments (PEI, RFA, and TACE) are employed to minimize drop-out from the transplant waiting list, which nevertheless occurs in 20% of patients

  • Living donor liver transplantation is an alternative treatment that can eliminate drop-out and enable liver transplant in patients with HCC beyond the Milan criteria

  • There is a need for more-effective medical therapies; newer agents targeting angiogenesis are promising in this regard

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Acknowledgements

This work was supported by NIH K24 award # DK 60498-01 entitled, “Systematic integration of patient-oriented research into the clinical pathway for hepatocellular carcinoma”, Myron Schwartz, MD Principal Investigator.

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Authors and Affiliations

  1. M Schwartz is Professor of Surgery, Director of Surgical Oncology, and Associate Director of Liver Transplantation, and S Roayaie is Assistant Professor of Surgery, at the Mount Sinai School of Medicine, New York, NY, USA.,

    Myron Schwartz & Sasan Roayaie

  2. M Konstadoulakis is Associate Professor of Surgery and Director of the Surgical Research Laboratory at the University of Athens, Athens, Greece.,

    Manousos Konstadoulakis

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  1. Myron Schwartz
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  2. Sasan Roayaie
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  3. Manousos Konstadoulakis
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Correspondence to Myron Schwartz.

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Schwartz, M., Roayaie, S. & Konstadoulakis, M. Strategies for the management of hepatocellular carcinoma. Nat Rev Clin Oncol 4, 424–432 (2007). https://doi.org/10.1038/ncponc0844

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