Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 18, 2015; 7(26): 2648-2663
Published online Nov 18, 2015. doi: 10.4254/wjh.v7.i26.2648
Hepatocellular carcinoma: A comprehensive review
Lisa P Waller, Vrushak Deshpande, Nikolaos Pyrsopoulos
Lisa P Waller, Vrushak Deshpande, Nikolaos Pyrsopoulos, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Author contributions: All three authors had been involved in creating the paper.
Conflict-of-interest statement: Nikolaos Pyrsopoulos, MD: Advisory board for GILEAD, BMS, ABBVIE research for ABBVIE.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nikolaos Pyrsopoulos, MD, PhD, MBA, FACP, AGAF, Chief of Division of Gastroenterology and Hepatology, Medical Director of Liver Transplantation, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, MSB H538, 185 South Orange Avenue, Newark, NJ 07103, United States.
Telephone: +1-973-9725252 Fax: +1-973-9723144
Received: April 2, 2015
Peer-review started: April 2, 2015
First decision: May 13, 2015
Revised: May 19, 2015
Accepted: October 14, 2015
Article in press: November 4, 2015
Published online: November 18, 2015

Hepatocellular carcinoma (HCC) is rapidly becoming one of the most prevalent cancers worldwide. With a rising rate, it is a prominent source of mortality. Patients with advanced fibrosis, predominantly cirrhosis and hepatitis B are predisposed to developing HCC. Individuals with chronic hepatitis B and C infections are most commonly afflicted. Different therapeutic options, including liver resection, transplantation, systemic and local therapy, must be tailored to each patient. Liver transplantation offers leading results to achieve a cure. The Milan criteria is acknowledged as the model to classify the individuals that meet requirements to undergo transplantation. Mean survival remains suboptimal because of long waiting times and limited donor organ resources. Recent debates involve expansion of these criteria to create options for patients with HCC to increase overall survival.

Keywords: Liver transplantation, Hepatectomy, Milan Criteria, Sorafenib, Living donor liver transplantation, Transarterial chemoembolization, Expansion Milan Criteria, Hepatocellular carcinoma, Mammalian target of rapamycin inhibitors, University of California San Francisco Criteria, Salvage liver transplantation

Core tip: Hepatocellular carcinoma (HCC) is the prominent Primary Hepatic tumor. Survival rates average between 6 and 20 mo, making Liver transplantation is the most efficient treatment. The established Milan Criteria is now widely accepted around the world for choosing patients suffering with HCC as liver transplant candidates. Due to high mortality rates, additional variables and tumor characteristics have been researched (example, University of California, San Francisco Criteria) in order to include more patients as candidates, so as to increase overall survival. In this comprehensive review, the pathophysiology, diagnostic modalities, and treatment options are thoroughly discussed.