Updates in the Management of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It forms about 7% of all cancers and is considered to be the third cause of cancer related deaths. East Asia is considered the most affected part. HCC is potentially curable with high incidence of mortality. Liver cirrhosis (due to hepatitis B, C, alcoholic related cirrhosis, and metabolic related disorders) is considered the main risk factor. Proper multidisciplinary teams are needed for proper management. The lines of treatment include liver resection and liver transplantation. Removal of the tumor with safety margin is considered the only way for recovery. Whenever surgery or transplantation is not achievable, local ablative therapies will be of benefit. These local modalities include radiofrequency ablation, radioembolisation, chemoembolisation, percutaneous ethanol ablation, and intrahepatic radiotherapy. They are able to prolong survival although they are of palliative nature. Systemic measures include chemotherapy,immunologic, hormonal therapies and molecular targeted therapies (Sorafenib). Other strategies include down staging and bridging that can improve the survival in patients with HCC on the waiting list waiting for liver transplantation.