Hepatocellular Carcinoma - A synopsis of current developments

Abstract

This review highlights the burden associated with hepatocellular carcinoma and the progress made so far in the diagnosis, management, and treatment of the disease. It is based on a search of Medline, the Cochrane database of Systemic Reviews, and citation lists of relevant and current publications. Subject headings and key words used included "hepatocellular carcinoma", "pathogenesis", "liver transplantation", "local ablative therapy”, and “novel drug therapies”. Additional information was obtained by a manual search of the references from the key articles, current advances in treatment. Only articles in English were included.

 Currently, surgical resection and liver transplantation are the treatment strategies offering the best long-term outcomes in patients with hepatocellular carcinoma. Non-transplant treatment as a bridge to transplantation also helps in lessening the risk of tumour progression or death during the waiting period. Targeted multi-cellular therapy with Sorafenib, is the first systemic agent to have yielded survival benefits in patients with advanced disease. Other agents: Brivanib, Erlotinib, monoclonal antibodies, Bevacizumab and Cetuximab, are currently being studied to determine their use in hepatocellular carcinoma.  Radionuclide Yttrium-90 microspheres, or combined subcutaneous interferon alpha and intra-arterial infusion chemotherapy, seem to be more promising strategies than Sorafenib treatment to downstage advanced hepatocellular carcinoma, including cases with macroscopic portal venous invasion.

Although numerous modalities of diagnosis and treatment of hepatocellular carcinoma have been studied, there is still need for further evaluation of newer adjuvant treatment to provide more effective and tolerable methods for the patients with hepatocellular carcinoma.

Keywords: Hepatocellular carcinoma, Hepato-carcinogenesis, Current diagnostic methods and techniques, Advances in treatment