Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma

Abstract

Evidence-based management of patients with hepatocellular carcinoma (HCC) is key to their optimal care. For individuals at risk for HCC, surveillance usually involves ultrasonography (there is controversy over use of biomarkers). A diagnosis of HCC is made based on findings from biopsy or imaging analyses. Molecular markers are not used in diagnosis or determination of prognosis and treatment for patients. The Barcelona Clinic Liver Cancer algorithm is the most widely used staging system. Patients with single liver tumors or as many as 3 nodules £3 cm are classified as having very early or early-stage cancer and benefit from resection, transplantation, or ablation. Those with a greater tumor burden, confined to the liver, and who are free of symptoms are considered to have intermediatestage cancer and can benefit from chemoembolization if they still have preserved liver function. Those with symptoms of HCC and/or vascular invasion and/or extrahepatic cancer are considered to have advanced-stage cancer and could benefit from treatment with the kinase inhibitor sorafenib. Patients with end-stage HCC have advanced liver disease that is not suitable for transplantation and/or have intense symptoms. Studies now aim to identify molecular markers and imaging techniques that can detect patients with HCC at earlier stages and better predict their survival time and response to treatment.

Phase III HEAT Study Adding Lyso-Thermosensitive Liposomal Doxorubicin to Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Lesions

“…RFA is considered a treatment option for early-stage and very early-stage HCC, as indicated in the widely accepted BCLC system (3,26). Although ablation is generally not recommended in intermediate-size HCC, it can be considered in select cases (27).…”

Oncogene dependent requirement of fatty acid synthase in hepatocellular carcinoma

“…7 Many other drugs, including tyrosine kinase inhibitors (TKIs) and Rapalogs, have also been tested in clinical trials, but none of them proved to be more effective than Sorafenib in HCC. [8][9][10][11] Thus, there is an obvious unmet medical need for new drug targets for the treatment of liver cancer.…”

Untitled

“…28 Regular screening for HCC can lead to early detection and curative treatment and may improve prognosis. 30,31 To demonstrate the clinical utility of HCC surveillance, detection must be possible in the early stages using regular screening, and early detection must facilitate the implementation of highly curative therapies, thereby leading to improved prognosis. 30,31 One randomized controlled trial showed that surveillance of HBV carriers with semiannual alpha-fetoprotein (AFP) testing and ultrasonography reduced HCC-related mortality by 37%.…”