Incidence, Diagnosis, and Management of Hepatocellular Carcinoma: Current Perspectives and Future Direction

Abstract

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and due to substantial morbidity and mortality, has proven a significant global health-economic burden. Treatment options are broad and include surgical approaches (i.e., transplantation and resection), radiological (i.e., percutaneous ablation, and trans arterial approaches) and systemic therapies, though treatment response often remains poor. As such, clinical decision making requires a multidisciplinary approach to improve treatment strategy after consideration of the patient's tumor stage, liver function, and performance status. Current systemic cytotoxic therapies for non-surgical candidates have largely remained unchanged over the last decade. Systemic therapies have extended life expectancy by up to 3 months but not without potential notable adverse effects that often limit their use. However, even if patients have necessary access to best treatment, survival outcomes remain concerningly poor. Improved understanding of the pathogenic role of advanced liver fibrosis and wider cancer biology is spearheading the development of targeted immunogenic therapies that appear to offer real promise. Importantly, limiting progression to cirrhosis and early detection of HCC in at risk groups, alongside best use of currently accessible therapeutic options, remains key across global healthcare systems. The focus of this review is to critically assess all current published literature, encapsulating the prevalence, diagnosis, and management of HCC, whilst looking ahead to the potential future therapeutic directions in HCC management.