[Hepatocellular Carcinoma: from Screening to Therapy]

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related death worldwide. The incidence is increasing globally, primarily due to the rising prevalence of chronic liver diseases. While chronic viral hepatitis (HBV, HCV) and alcohol abuse have traditionally been considered the main risk factors, metabolic dysfunction-associated steatohepatitis (MASH) is increasingly gaining importance, especially in Western industrialized nations. In the vast majority of cases, HCC develops on the basis of liver cirrhosis. When cirrhosis is present, diagnosis can usually be reliably made through dynamic imaging techniques. However, despite established surveillance programs, most cases of HCC are often diagnosed only at advanced stages, which significantly limits therapeutic options. The treatment of HCC depends on tumor stage, overall health, and liver function of the affected patients. Selecting the appropriate therapy requires a multidisciplinary decision-making process. While curative options include resection, transplantation, and local ablation, advanced stages are managed with loco-regional therapies or systemic treatments. In recent years, the therapeutic spectrum has been significantly expanded by the introduction of immune checkpoint inhibitors. Particularly, immunotherapeutic combination therapies approved for first-line treatment have significantly improved the overall survival of patients with advanced HCC. Nevertheless, the prognosis remains unfavorable in many cases, highlighting the need for further research to identify predictive biomarkers and develop innovative therapies.