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Logo of bttDove Medical PressThis ArticleSubscribeSubmit a ManuscriptSearchFollowDovepressBiologics: Targets and Therapy
 
Biologics. 2012; 6: 207–219.
Published online Jul 17, 2012. doi:  10.2147/BTT.S23907
PMCID: PMC3421475
Hepatocellular carcinoma: natural history, current management, and emerging tools
Christopher L Tinkle and Daphne Haas-Kogan
Department of Radiation Oncology, University of California, San Francisco, CA, USA
Correspondence: Daphne Haas-Kogan, Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94115-1708, USA, Phone +1 415 353 7187, Fax +1 415 353 9883, Email dhaaskogan/at/radonc.ucsf.edu
Received July 17, 2012
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver tumor and represents the third-leading cause of cancer-related death in the world. The incidence of HCC continues to increase worldwide, with a unique geographic, age, and sex distribution. The most important risk factor associated with HCC is liver cirrhosis, with the majority of cases caused by chronic infection with hepatitis B (HBV) and C (HCV) viruses and alcohol abuse, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary prevention in the form of HBV vaccination has led to a significant decrease in HBV-related HCC, and initiation of antiviral therapy appears to reduce the incidence of HCC in patients with chronic HBV or HCV infection. Additionally, the use of ultrasonography enables the early detection of small liver tumors and forms the backbone of recommended surveillance programs for patients at high risk for the development of HCC. Cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, represent further noninvasive techniques that are increasingly employed to diagnose HCC in patients with cirrhosis. The mainstay of potentially curative therapy includes surgery – either resection or liver transplantation. However, most patients are ineligible for surgery, because of either advanced disease or underlying liver dysfunction, and are managed with locoregional and/or systemic therapies. Randomized controlled trials have demonstrated a survival benefit with both local therapies, either ablation or embolization, and systemic therapy in the form of the multikinase inhibitor sorafenib. Despite this, median survival remains poor and recurrence rates significant. Further advances in our understanding of the molecular pathogenesis of HCC hold promise in improving the diagnosis and treatment of this highly lethal cancer.
Keywords: hepatocellular carcinoma, viral hepatitis, liver transplantation, ablation, embolization, sorafenib
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