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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma

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Published on: September 30, 2021

Treatment algorithms for managing hepatocellular carcinoma.

Vivek A Saraswat¹, Gaurav Pandey¹, Sachin Shetty¹

¹Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Journal of Clinical and Experimental Hepatology

|March 11, 2015

Summary

Early diagnosis and treatment of hepatocellular carcinoma (HCC) improve outcomes. The Barcelona Clinic Liver Cancer (BCLC) system provides an algorithmic approach for staging and treatment planning, guiding optimal patient care.

Keywords:

AJCC–UICC, American Joint Committee on Cancer and Union for International Cancer Control ALT, alanine aminotransferase BCLC BCLC, Barcelona Clinic Liver Cancer CEUS, contrast-enhanced ultrasound CLIP, Cancer of the Liver Italian Program CTP, Child–Turcotte–Pugh criteria CUPI, Chinese University Prognostic Index EASL, European expert panel EBRT, external beam radiotherapy HCC, hepatocellular carcinoma JIS, Japanese integrated system LT, liver transplantation MAA, macro-aggregate albumin MCT, microwave coagulation therapy MWA, microwave ablation NCCN, National Comprehensive Cancer Network PAI, percutaneous acetic acid injection PEI, percutaneous ethanol injection PLT, primary LT RBV, ribavirin RECIST, response evaluation criteria in solid tumors RFA, radiofrequency ablation SIRT, Selective Internal Radiation Treatment SLT, salvage liver transplant TACE, trans-catheter arterial chemo-embolization TACE-DEB, TACE with drug eluting beads TAE, transarterial embolization TAI, trans-catheter hepatic arterial infusion TARE, transarterial radio-embolization TNM, Tumor-Node-Metastasis WHO, World Health Organization bm-JIS, biomarker JIS liver cancer staging treatment algorithm

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Area of Science:

Hepatology
Oncology
Gastroenterology

Background:

Hepatocellular carcinoma (HCC) management requires early diagnosis and tailored therapy.
Treatment decisions for HCC depend on tumor extent, liver function, and resource availability.
Post-treatment surveillance is crucial for recurrent HCC and underlying cirrhosis progression.

Purpose of the Study:

To review the role of a systematic, algorithmic approach in optimizing hepatocellular carcinoma (HCC) therapy.
To highlight the Barcelona Clinic Liver Cancer (BCLC) system for HCC staging and treatment allocation.
To discuss comprehensive care for patients with cirrhosis, including management of liver disease and complications.

Main Methods:

Review of current treatment options for hepatocellular carcinoma (HCC).
Emphasis on the Barcelona Clinic Liver Cancer (BCLC) staging system and its application.
Discussion of factors influencing treatment choice and post-therapy management.

Main Results:

The Barcelona Clinic Liver Cancer (BCLC) system offers a framework for classifying HCC patients into stages: very early, early, intermediate, advanced, and terminal.
The BCLC system integrates tumor status, liver function, and overall health for treatment allocation.
While effective, the BCLC system has limitations, particularly for BCLC stages B and C disease.

Conclusions:

An algorithmic approach, exemplified by the BCLC system, is essential for personalized HCC treatment planning.
Comprehensive management of underlying liver disease is critical for long-term survival in HCC patients.
Continued research and refinement of staging systems like BCLC are needed to improve HCC patient outcomes.