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Hepatocellular carcinoma: early-stage management challenges

Authors Erstad DJ, Tanabe KK

Received 28 February 2017

Accepted for publication 2 May 2017

Published 23 June 2017 Volume 2017:4 Pages 81—92


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Ahmed Kaseb

Derek J Erstad,1 Kenneth K Tanabe2–4

1Department of Surgery, Massachusetts General Hospital, 2Harvard Medical School, 3Division of Surgical Oncology, 4Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA

Abstract: Hepatocellular carcinoma (HCC) is a major cause of cancer death and is increasing in incidence. This review focuses on HCC surveillance and treatment of early-stage disease, which are essential to improving outcomes. Multiple societies have published HCC surveillance guidelines, but screening efforts have been limited by noncompliance and overall lack of testing for patients with undiagnosed chronic liver disease. Treatment of early-stage HCC has become increasingly complex due to expanding therapeutic options and better outcomes with established treatments. Surgical indications for HCC have broadened with improved preoperative liver testing, neoadjuvant therapy, portal vein embolization, and perioperative care. Advances in post-procedural monitoring have improved efficacies of transarterial chemoembolization and radiofrequency ablation, and novel therapies involving delivery of radiochemicals are being studied in small trials. Finally, advances in liver transplantation have allowed for expanded indications beyond Milan criteria with non-inferior outcomes. More clinical trials evaluating new therapies and multimodal regimens are necessary to help clinicians design better treatment algorithms and improve outcomes.

Keywords: hepatocellular carcinoma, hepatitis, surveillance, Barcelona clinic liver cancer, staging, cirrhosis, hepatectomy, hepatic resection, locoregional therapy, radiofrequency ablation, transarterial chemoembolization, liver transplantation

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