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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 12003-12021
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12003
Diagnostic and therapeutic management of hepatocellular carcinoma
Francesco Bellissimo, Marilia Rita Pinzone, Bruno Cacopardo, Giuseppe Nunnari
Francesco Bellissimo, Marilia Rita Pinzone, Bruno Cacopardo, Giuseppe Nunnari, Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Catania, 95100 Catania, Italy
Author contributions: Bellissimo F searched the literature; Bellissimo F and Pinzone MR wrote the paper; Cacopardo B and Nunnari G revised the manuscript; all the authors approved the final version of the manuscript to be published.
Conflict-of-interest statement: No conflict of interest.
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: Giuseppe Nunnari, MD, PhD, MPH, Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Catania, Via Palermo 636, 95100 Catania, Italy. gnunnari@hotmail.com
Telephone: +39-95-7598443 Fax: +39-95-7598666
Received: June 30, 2015
Peer-review started: July 4, 2015
First decision: July 20, 2015
Revised: August 3, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Abstract

Hepatocellular carcinoma (HCC) is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines.

Keywords: Cancer, Chronic hepatitis, Cirrhosis, Hepatitis B virus, Hepatocellular carcinoma, Hepatitis C virus, Liver

Core tip: Hepatocellular carcinoma is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for hepatocellular carcinoma (HCC) is cirrhosis. Early diagnosis is crucial for curative treatments. As a consequence, patients at risk of developing HCC should undergo surveillance programs in order to detect HCC in the initial stage. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization.