Gastroenterology

Gastroenterology

Volume 134, Issue 6, May 2008, Pages 1752-1763
Gastroenterology

Introduction
Diagnosis and Treatment of Hepatocellular Carcinoma

https://doi.org/10.1053/j.gastro.2008.02.090Get rights and content

The diagnosis and treatment of hepatocellular carcinoma (HCC) have witnessed major changes over the past decade. Until the early 1990s, HCC was a relatively rare malignancy, typically diagnosed at an advanced stage in a symptomatic patient, and there were no known effective palliative or therapeutic options. However, the rising incidence of HCC in several regions around the world coupled with emerging evidence for efficacy of screening in high-risk patients, liver transplantation as a curative option in select patients, ability to make definitive diagnosis using high-resolution imaging of the liver, less dependency on obtaining tissue diagnosis, and proven efficacy of transarterial chemoembolization and sorafenib as palliative therapy have improved the outlook for HCC patients. In this article, we present a summary of the most recent information on screening, diagnosis, staging, and different treatment modalities of HCC, as well as our recommended management approach.

Section snippets

Diagnosis of Hepatocellular Carcinoma

Cirrhosis is the strongest and the most common known risk factor for hepatocellular carcinoma (HCC), particularly cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infections.1, 2, 3 In addition, HBV acquired in the perinatal period and early childhood is associated with increased risk of HCC even in the absence of cirrhosis.

Treatment of HCC

The management of HCC involves multiple disciplines including hepatology, surgery, diagnostic and interventional radiology, oncology, and pathology. One has to consider several patient and tumor factors including the severity of underlying liver disease, tumor bulk, and associated comorbidities as well as several practice-setting factors including availability and expertise in surgical resection, transplantation, and ablative therapies.

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