[Hepatocellular carcinoma. Pathogenesis and multicentricity]

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world, with an extremely poor prognosis. The clinical and molecular pathogenesis of HCC is very complex and involves alterations in the structure or expression of several tumor suppressor genes, oncogenes and, possibly, mechanisms leading to genetic instability due to mismatch repair deficiency or chromosomal instability and aneuploidy due to defective chromosomal segregation. Central to the molecular pathogenesis of HCC are mutations of various genes and a genetic instability which, in most cases, result from chronic liver disease and the associated enhanced liver cell regeneration and mitotic activity. The prognosis is generally very poor. Most studies report a 5-year survival rate of less than 5% in symptomatic HCC patients. Therapeutic strategies include resection, liver transplantation, and nonsurgical interventions such as percutaneous ethanol injection, radiofrequency thermal ablation, transarterial embolization, and chemoembolization. HCC has been shown to be quite resistant to radio- and chemotherapy.