Management of hepatocellular carcinoma: Enlightening the gray zones

• Published in: World journal of hepatology 2013-06, Vol.5 (6), p.302-310
• Main Author: Mancuso, Andrea
• Format: Article
• Language: English
• Subjects: carcinoma; chemoembolization; Hepatocellular; liver; Management; Orthotopic; Review; Surgery; Trans-arterial; transplantation
• ISSN: 1948-5182; 1948-5182
• DOI: 10.4254/wjh.v5.i6.302

Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. HCC is a worldwide clinical and social issue and typically a complicates cirrhosis. The incidence of HCC is increasing, not only in the general population of patients with cirrhosis, but particularly in some subgroups of patients, like those with human immunodeficiency virus infection or thalassemia. Since a 3% annual HCC incidence has been estimated in cirrhosis, a biannual screening is generally suggested. The diagnostic criteria of HCC has recently had a dramatic evolution during recent years. HCC diagnosis is now made only on radiological criteria in the majority of the cases. In the context of cirrhosis, the universally accepted criteria for HCC diagnosis is contrast enhancement in arterial phase and washout in venous/late phase at imaging, the so called "typical pattern". However, recently up- dated guidelines slightly differ in diagnostic criteria. Apart from liver transplantation, the only cure of both HCC and underlying liver cirrhosis, all the other treatments have to match with higher rate of HCC recurrence. The latter can be classified into curative (resection and percutaneous ablation) and palliative treatments. The aim of this paper was to review the currentknowledge on management of HCC and to enlighten the areas of uncertainty.