Management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide and increasing in incidence worldwide driven largely by the HCV epidemic. With current treatment modalities, outcomes for HCC are improving. Liver transplantation is a good option for patients with HCC within transplant criteria (Milan criteria) and portal hypertension. Expansion of criteria for transplantation is being considered and downstaging HCC to within transplant criteria is being used in some centers using locoregional therapy. Waiting time after locoregional therapy is currently the best predictor of recurrence. Resection is reserved for patients with small tumors without significant portal hypertension. Locoregional therapies are useful as bridging therapy for patients awaiting liver transplantation and as palliative therapies in patient with unresectable HCC. In selected patients with small HCC they can have comparable outcomes to resection. The role of newer chemotherapeutics for unresectable disseminated HCC is increasing and they are being tested as part of neoadjuvant therapy after resection or logoregional therapy. Further research in good biologic predictors of HCC recurrence is needed and will be invaluable in planning therapies.