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World J Hepatol. Mar 27, 2015; 7(3): 566-574
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.566
Treatment of hepatocellular carcinoma: Steps forward but still a long way to go
Liat Mlynarsky, Yoram Menachem, Oren Shibolet
Liat Mlynarsky, Yoram Menachem, Oren Shibolet, Liver unit, Department of Gastroenterology, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 64239, Israel
Author contributions: Mlynarsky L wrote the paper; Menachem Y critically reviewed and revised it; and Shibolet O wrote, revised and finally approved the version to be published.
Conflict-of-interest: The authors have 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:
Correspondence to: Oren Shibolet, MD, Director of the Liver Unit, Department of Gastroenterology, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, 6 Weizman St. Tel-Aviv 64239, Israel.
Telephone: +972-3-6973984 Fax: +972-3-6966286
Received: August 9, 2014
Peer-review started: August 11, 2014
First decision: August 28, 2014
Revised: October 6, 2014
Accepted: December 29, 2014
Article in press: December 29, 2014
Published online: March 27, 2015

Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third cause of tumor associated deaths worldwide. HCC incidence rates are increasing in many parts of the world including developing and developed countries. Potentially curative treatments for HCC are resection and liver transplantation, but these are only suitable for patients with small tumors, meeting strict pre-defined criteria, or well-compensated liver disease. Early diagnosis of HCC can be achieved by surveillance of at-risk populations. For patients with non-resectable disease treatments modalities include loco-ablative and systemic therapies. In this review we focus on treatment options in HCC and their allocation. Although significant research is in progress, to this date, the results are unsatisfactory with limited long-term survival. In the fight against this deadly disease, there is still a long way to go.

Keywords: Hepatocellular carcinoma, Liver resection, Liver transplantation, Loco-ablative therapies, Sorafenib

Core tip: We chose to focus on the aspect of treatment modalities of hepatocellular carcinoma (HCC) and discuss the benefits and disadvantages of each modality. We report on the diversity of treatments and the allocation of patients with HCC to the different modalities according to the Barcelona-Clinic Liver Cancer. Moreover, we discuss novel treatments currently under investigation and not yet recommended by acceptable guidelines.