The size of the problem: clinical algorithms

Hepatocellular carcinoma (HCC) is a highly prevalent and lethal neoplasia. Current data show that it is the main cause of death in patients with cirrhosis. A better knowledge of the natural history of the tumor and the development of staging systems have led to a better prediction of prognosis and to a most appropriate treatment approach. The Barcelona Clinic Liver Cancer (BCLC) system has become the preferred staging system since it takes into account the characteristics of the tumor, the degree of liver impairment and the physical performance. In addition, it is the only one that links prognosis assessment with treatment recommendation. Curative therapies such as resection, transplantation and ablation can improve survival in patients diagnosed at an early HCC stage and may offer a long-term cure. Patients with intermediate-stage HCC benefit from chemoembolization and those diagnosed at an advanced stage benefit from sorafenib, an oral available, multikinase inhibitor with antiangiogenic and antiproliferative effects. Further efforts are needed to improve the survival of this lethal neoplasia.