Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment
Soo Young Hwang1, Pojsakorn Danpanichkul2, Vatche Agopian3
1Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, Maryland, USA.
Insights
Hepatocellular carcinoma (HCC) is a leading cause of cancer death. While viral causes decrease, metabolic and alcohol-related HCC rise, necessitating updated surveillance and treatment strategies for this liver cancer.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) remains a significant global health challenge, contributing to high cancer mortality rates.
- While hepatitis B and C virus-related HCC incidence is declining due to vaccination and antiviral therapies, there is a concerning rise in HCC linked to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease.
Purpose of the Study:
- To review the current global epidemiology, risk factors, and the comprehensive care continuum for hepatocellular carcinoma.
- To discuss advancements and challenges in HCC surveillance, diagnosis, staging, and treatment strategies.
Main Methods:
- Literature review of recent global data on HCC epidemiology and risk factors.
- Analysis of current surveillance modalities, including ultrasonography, α-fetoprotein, and emerging tools like biomarker panels and abbreviated MRI.
- Examination of diagnostic standards, staging complexity, and multidisciplinary treatment approaches for HCC.
Main Results:
- Surveillance for high-risk patients typically involves biannual liver ultrasonography and serum α-fetoprotein, with novel methods under investigation.
- Diagnosis relies on cross-sectional imaging (CT/MRI), with histology considered for ambiguous cases.
- Treatment is stratified by stage: curative options for early-stage, locoregional therapies for intermediate, and immune checkpoint inhibitors for advanced HCC.
Conclusions:
- The landscape of HCC is shifting towards metabolic and alcohol-related etiologies, requiring adaptation in surveillance and management.
- Multidisciplinary decision-making is crucial for tailoring complex HCC treatments based on tumor burden, liver function, and patient factors.
- Continued research into novel surveillance tools and systemic therapies is essential for improving outcomes in hepatocellular carcinoma care.
Abstract:
Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.
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