Guide for diagnosis and treatment of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is ranked as the 5^th common type of cancer worldwide and is considered as the 3^rd common reason for cancer-related deaths. HCC often occurs on top of a cirrhotic liver. The prognosis is determined by several factors; tumour extension, alpha-fetoprotein (AFP) concentration, histologic subtype of the tumour, degree of liver dysfunction, and the patient’s performance status. HCC prognosis is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Analysis of recent studies showed that AFP assessment lacks adequate sensitivity and specificity for effective surveillance and diagnosis. Many tumour markers have been tested in clinical trials without progressing to routine use in clinical practice. Thus, surveillance is still based on ultrasound (US) examination every 6 mo. Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography and CT arterial portography in addition to the conventional hepatic angiography. This article provides an overview and spotlight on the different diagnostic modalities and treatment options of HCC.

Keywords: Diagnosis of hepatocellular carcinoma; Surgical resection; Hepatocellular carcinoma; Liver transplantation; Radiofrequency ablation; Microwave ablation; Percutaneous ethanol or acetic acid ablation; Radio-embolisation; Systemic chemotherapy; Trans-arterial chemoembolisation

Core tip: This review aims to spotlight on the different diagnostic modalities, and treatment options of hepatocellular carcinoma (HCC). Despite lack of adequate sensitivity of ultrasound (US) examination and alpha-fetoprotein, both are still considered the cornerstone for surveillance for HCC. So, a plethora of clinical studies searching for a more ideal tool are running. One of these tools is the microRNAs which can be considered as a promising diagnostic as well as prognostic tool for HCC. This review discusses the diagnostic utility of computed tomography and magnetic resonance imaging, as well as the enhanced US efficacy in diagnosis of HCC. Management of HCC depends on the tumour stage, liver function reserve, and patient performance status, and requires a multidisciplinary approach for optimal treatment. Liver transplantation and hepatic resection are the only curative options in early stage of disease. In addition, radiofrequency ablation is equivalent to surgical resection in well-selected patients. Radioembolization with use of resin or glass sphere appear promising. Novel molecular therapies are also discussed. For patients with advanced disease, sorafenib is the only approved therapy, but novel targeted agents and their combinations are emerging.