Diagnostics and Treatment of Hepatocellular Carcinoma in 2016: Standards and Developments

Abstract

<b><i>Background:</i></b> Hepatocellular carcinoma (HCC) is a frequent complication of liver cirrhosis. Worldwide, HCC is one of the most common cancers, with a rising incidence. <b><i>Methods:</i></b> A selective literature search was conducted, taking into account current studies, reviews, meta-analyses, and guidelines. <b><i>Results:</i></b> The diagnosis is established either non-invasively by dynamic imaging, showing a typical contrast enhancement and wash-out, or histopathologically. Pathological diagnosis of HCC is recommended for all atypical nodules in patients with cirrhosis and for those in non-cirrhotic patients. Tumor therapy as well as treatment of the underlying chronic liver disease and/or preservation of liver function are important for the management of patients with HCC. Standard stage-adapted treatments are based on the widely applied Barcelona Clinic Liver Cancer staging system including liver resection and transplantation, interventional treatments such as thermal ablation and transarterial therapies, and systemic treatment with the tyrosine kinase inhibitor sorafenib. After failure of sorafenib, anti-angiogenic drugs, MET inhibitors, and immunotherapeutics are currently under advanced clinical investigation. <b><i>Conclusion:</i></b> Treatment of HCC is multidisciplinary and therefore requires a close cooperation between various disciplines such as hepatology, visceral surgery, radiology, and oncology to achieve the best outcome depending on the tumor stage and degree of liver function impairment.

Recent advances in hepatocellular carcinoma therapy

“…The stimulus for HCC development in Asian and African countries arises from factors like chronic hepatitis B and C viral infection, chronic alcohol consumption, aflatoxin-contaminated food intake, other hereditary diseases (hemochromatosis due to iron overload in the body) and liver cirrhosis (Farazi & DePinho, 2006; Ge & Huang, 2015; Ghasemi, Rostami, & Meshkat, 2015). In the developed countries, the epidemiological evidence connecting the pathologies are type 2 diabetes, obesity, metabolic disorders and non-alcoholic steatohepatitis (NASH) as part of non-alcoholic fatty liver diseases (NAFLD) (Reeves, Zaki, & Day, 2016; Trojan, Zangos, & Schnitzbauer, 2016). The risk factors susceptible for the occurrence of HCC are more common in the male population compared to the females (4:1) (Yang, Ekanem, Sakyi, & Ray, 2015).…”

“…Computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and dynamic multiphasic multi-detector-row CT (MDCT) are the standard HCC diagnostic methods (Bertino et al, 2014; Daoudaki & Fouzas, 2014). Based on the tumor size, serum albumin, bilirubin and α-fetoprotein (AFP) levels, HCC morphology, presence of portal vein thrombosis and ascites, various classifications are used in order to categorize the stage of the disease, particularly Okuda staging system (I-III), Cancer of Liver Italian Program (CLIP) score (0-6), Barcelona Clinic Liver Cancer (BCLC) (Table 1), American Association for the Study of the Liver Disease (AASLD), National Comprehensive Cancer Network (NCCN) and European Association for the Study of the Liver (EASL) are noteworthy (Bertino et al, 2014; Trojan et al, 2016). Apart from liver transplantation, tumor local ablation, embolization, (Transcatheter arterial chemoembolization/transarterial chemoembolization or TACE) and chemotherapy are often recommended for patients with BCLC stage B-C (Table 1) (Bruix et al, 2011; Trojan et al, 2016).…”

Proliferation of sphere-forming hepatocellular carcinoma cells is suppressed in a medium without glucose and arginine, but with galactose and ornithine

“…Hepatocellular carcinoma (HCC) is a common cancer of the liver with a typically poor prognosis (1). The current treatment for HCC involves local ablation, surgical resection, transcatheter arterial chemoembolization and systemic administration of chemotherapeutic agents (2,3).…”

Viral Hepatitis and Its Complications

“…The standards of current treatment together with an outlook on future developments are delineated by Trojan et al [6].…”