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Management patients at risk for hepatocellular carcinoma

Mario Niklas

The most frequent type of primary liver cancer is hepatocellular carcinoma (HCC). Despite attempts at prevention and screening, as well as the development of novel diagnostic and treatment technologies, the prevalence of HCC has doubled in recent decades, and fatality rates have risen. HCC is linked to a number of crucial risk factors, with any type of cirrhosis, regardless of cause, being the most significant contributor. Hepatitis C virus infection with cirrhosis or bridging fibrosis is a separate risk factor from hepatitis B virus infection. In the majority of cases, HCC is diagnosed without a liver biopsy. Ultrasound and alpha-fetoprotein (AFP) screening at intervals is recommended, however it is insufficient for patients on the orthotopic liver transplantation (OLT) waiting list. Due to their greater sensitivity and specificity, triple-phase computed tomography and/or magnetic resonance imaging are utilised in conjunction with the detection of AFP, AFP-L3 percent, and/or des-gamma-carboxy prothrombin. There are several therapy options, but only surgical resection and OLT are curative. Only patients who meet or are downstaged into Milan or University of California, San Francisco criteria are eligible for OLT. Radiofrequency ablation, microwave ablation, percutaneous ethanol injection, transarterial chemoembolization, radioembolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, and molecularly targeted medicines are some of the additional treatment options. The size and location of the tumour, extrahepatic metastasis, and underlying liver function all play a role in HCC treatment. Because of the disease's intricacy, patients are frequently best managed in centres with experience with HCC, where a multidisciplinary approach can be used