Review
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World J Hepatol. Jun 27, 2013; 5(6): 302-310
Published online Jun 27, 2013. doi: 10.4254/wjh.v5.i6.302
Management of hepatocellular carcinoma: Enlightening the gray zones
Andrea Mancuso
Andrea Mancuso, Epatologia e Gastroenterologia, Ospedale Niguarda Cà Granda, 20162 Milano, Italy
Andrea Mancuso, Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione, Ospedale Civico, 90127 Palermo, Italy
Author contributions: Mancuso A solely contributed to this paper.
Correspondence to: Andrea Mancuso, MD, Epatologia e Gastroenterologia, Ospedale Niguarda Ca’ Granda, Piazza Maggiore 3, 20162 Milano, Italy. mancandrea@libero.it
Telephone: +39-2-64444435 Fax: +39-2-64442895
Received: March 7, 2013
Revised: May 15, 2013
Accepted: May 18, 2013
Published online: June 27, 2013
Processing time: 112 Days and 5.4 Hours
Abstract

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 bi-annual 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 updated 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 current knowledge on management of HCC and to enlighten the areas of uncertainty.

Keywords: Hepatocellular carcinoma; Management; Trans-arterial chemoembolization; Orthotopic liver transplantation; Surgery; Management

Core tip: Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. The aim of this paper was to review the current knowledge on management of HCC and to enlighten the areas of uncertainty.