Overview
Hepatocellular carcinoma (HCC) is a cancer originating from the liver, as
stated in the Introduction
section.
Hepatocellular carcinoma is the most common type of primary
liver cancer, accounting for 75-85% of cases and is the fourth leading cause of
cancer mortality worldwide. A detailed discussion about the prevalence of hepatocellular
carcinoma is in the Epidemiology
section.
Approximately 80% of hepatocellular carcinoma cases are caused by
hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection, especially in
those with cirrhosis. Other factors that may increase the risk for
hepatocellular carcinoma are in the Etiology section.
The Risk Factors section states that the presence of cirrhosis
and chronic liver disease, regardless of etiology, are the major risk factors
for the development of hepatocellular carcinoma.
The Classification section features the types of hepatocellular
carcinoma by morphology.
Hepatocellular Carcinoma_Disease SummaryHistory and Physical Examination
The Clinical Presentation section describes the clinical features suggestive of localized and more advanced hepatocellular carcinoma.
Diagnosis
The Diagnosis or
Diagnostic Criteria section
features the criteria of the 2018 American Association for the Study of Liver
Diseases (AASLD) guidelines based on the Liver Imaging Reporting and Data
System (LI-RADS).
The Screening section features methods such as serum alpha
fetoprotein, ultrasonography, computed tomography (CT), and magnetic resonance
imaging (MRI) in screening patients at risk for hepatocellular carcinoma.
Discussion on liver biopsy and serum biomarkers in the
evaluation of hepatocellular carcinoma is in the Laboratory
Tests and Ancillaries section.
The Imaging section discusses 4-phase multidetector computed
tomography and contrast-enhanced dynamic magnetic resonance imaging as the
primary diagnostic examination of hepatocellular carcinoma.
Other diseases that should be ruled out in the diagnosis of
hepatocellular carcinoma are listed in the Differential Diagnosis section.
Management
Once the diagnosis of hepatocellular carcinoma is
established, tumor burden, liver function and reserve, general health, and
comorbidities of the patient should be assessed. Preoperative imaging and
assessments, Child-Pugh scoring, various criteria (eg United Network for Organ
Sharing, Milan staging) and pre-arterial directed therapies assessment are
discussed in the Evaluation
section. The staging of hepatocellular carcinoma is also explained in this
section.
General therapy principles for surgery, locoregional therapy,
and systemic therapy in the management of hepatocellular carcinoma are in the Principles of Therapy section.
The Pharmacological
Therapy section discusses in
detail treatment options such as protein kinase inhibitors, cancer
immunotherapy or immunomodulating agents, antiviral therapy, and
investigational agents in the management of hepatocellular carcinoma.
The Non-pharmacological
section discusses
ablation therapies such as microwave ablation (MWA), percutaneous ethanol
injection (PEI), radiofrequency ablation (RFA), irreversible electroporation
(IRE), and arterially directed therapies that include hepatic arterial infusion
chemotherapy (HAIC), transarterial bland embolization (TAE), and transarterial
chemoembolization (TACE), in the treatment of hepatocellular carcinoma.
Liver resection and liver transplantation, as a curative
therapy in hepatocellular carcinoma, is in the Surgery section.
The Radiation Therapy section identifies treatment options for
hepatocellular carcinoma such as stereotactic body radiation therapy (SBRT) and
selective internal radiation therapy (SIRT).
The Monitoring section
discusses follow-up methods for surveillance after treatment in the management
of hepatocellular carcinoma.
