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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2015; 7(3): 362-376
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.362
Diagnosis and treatment of hepatocellular carcinoma: An update
Javier Tejeda-Maldonado, Ignacio García-Juárez, Jonathan Aguirre-Valadez, Adrián González-Aguirre, Mario Vilatobá-Chapa, Alejandra Armengol-Alonso, Francisco Escobar-Penagos, Aldo Torre, Juan Francisco Sánchez-Ávila, Diego Luis Carrillo-Pérez
Javier Tejeda-Maldonado, Diego Luis Carrillo-Pérez, Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14000 Mexico City, Mexico
Ignacio García-Juárez, Jonathan Aguirre-Valadez, Aldo Torre, Juan Francisco Sánchez-Ávila, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14000 Mexico City, Mexico
Adrián González-Aguirre, Department of Interventional Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14000 Mexico City, Mexico
Mario Vilatobá-Chapa, Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14000 Mexico City, Mexico
Alejandra Armengol-Alonso, Francisco Escobar-Penagos, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14000 Mexico City, Mexico
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest: None reported.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Diego Luis Carrillo-Pérez, MD, Department of Internal Medicine. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col Sección XVI, Tlalpan, 14000 Mexico City, Mexico. djiego51@gmail.com
Telephone: +52-55-54870900 Fax: +52-55-55731075
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: November 14, 2014
Revised: December 11, 2014
Accepted: December 29, 2014
Article in press: December 29, 2014
Published online: March 27, 2015
Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion’s stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib.

Keywords: Hepatocellular carcinoma, Surveillance, Liver transplant, Sorafenib, Catheter ablation

Core tip: This paper reviews the most recent evidence on hepatocarcinoma including its molecular pathogenesis and prognosis, with special emphasis on its diagnosis, staging and treatment. The most recent Easter and Western international guidelines are also reviewed.