Multidisciplinary perspective of hepatocellular carcinoma: A Pacific Northwest experience

Abstract

Hepatocellular carcinoma (HCC) is the most rapidly increasing type of cancer in the United States. HCC is a highly malignant cancer, accounting for at least 14000 deaths in the United States annually, and it ranks third as a cause of cancer mortality in men. One major difficulty is that most patients with HCC are diagnosed when the disease is already at an advanced stage, and the cancer cannot be surgically removed. Furthermore, because almost all patients have cirrhosis, neither chemotherapy nor major resections are well tolerated. Clearly there is need of a multidisciplinary approach for the management of HCC. For example, there is a need for better understanding of the fundamental etiologic mechanisms that are involved in hepatocarcinogenesis, which could lead to the development of successful preventive and therapeutic modalities. It is also essential to define the cellular and molecular bases for malignant transformation of hepatocytes. Such knowledge would: (1) greatly facilitate the identification of patients at risk; (2) prompt efforts to decrease risk factors; and (3) improve surveillance and early diagnosis through diagnostic imaging modalities. Possible benefits extend also to the clinical management of this disease. Because there are many factors involved in pathogenesis of HCC, this paper reviews a multidisciplinary perspective of recent advances in basic and clinical understanding of HCC that include: molecular hepatocarcinogenesis, non-invasive diagnostics modalities, diagnostic pathology, surgical modality, transplantation, local therapy and oncological/target therapeutics.

Keywords: Genetic alterations, Epigenetic alterations, Diagnostic pathology, Diagnostic imaging, Surgical modality, Liver transplantation, Locoregional therapy, Sorafenib, Hepatocellular carcinoma, Liver resection

Core tip: Hepatocellular carcinoma (HCC) is one of the few tumors in which the incidence is on the rise worldwide, especially in the United States. The overall increase in the incidence warrants efforts to prevent and to more efficiently treat this disease. This necessitates the need for a multidisciplinary approach for the management of HCC, because there are many etiological factors involved in the pathogenesis and malignant transformation of the disease. For example, there is a need to improve surveillance and early diagnosis through diagnostic imaging modalities to facilitate identification of potential molecular targets for novel therapeutic strategies. In turn, this will facilitate the identification of patients at risk. This review summarizes current knowledge on the clinical management of the disease as well as etiologic mechanisms of malignant transformation for better diagnosis, prognosis, and treatment of HCC.