Management of hepatocellular carcinoma: staging and treatment

Hepatocellular carcinoma (HCC) is a common malignancy worldwide. Viral hepatitis B and C and cirrhosis are the most important risk factors. The two most established methods of screening are ultrasound and alpha-fetoprotein serum levels followed serially. The intervals of testing and cost efficacy have not yet been established. When HCC is discovered staging is important in order to guide treatment. Assessment for portal vein patency by ultrasonography and dynamic CT are noninvasive and sensitive. Magnetic resonance imaging and lipiodol CT are also helpful. The treatment depends on the patient's clinical condition related to liver function and other comorbid conditions and the number, size, and location of the lesions. The roles of tumor resection, liver transplantation, percutaneous alcohol injection, transarterial chemoembolization, and systemic chemotherapy are dependent on staging. Careful selection of patients and combined treatment modalities may be the keys to improve survival.