The European approach to hepatocellular carcinoma

Patients with cirrhosis of viral, metabolic or autoimmune origin are at high risk of developing hepatocellular carcinoma. Prospective surveillance based on semi-annual ultrasound examination of the abdomen has allowed for detection of small tumors in many patients, but it is not clear whether liver-related mortality was decreased in parallel. Prognostication in patients with hepatocellular carcinoma requires integrated assessment of tumor size and number, liver function and performance status. The therapeutic approach is to a large extent non-evidence based and the best treatment choice depends on individual patients characteristics, taking into account the local technological and therapeutic resources and skills. Since surgical resection, liver transplantation and percutaneous ablation have achieved a high rate of complete response in properly selected patients, these procedures are considered curative treatments. Being curative treatments applicable only to patients with a small tumor, hepatocellular carcinoma surveillance aimed at early detection of the tumor is the most practical approach for improving treatment outcome.