New progress in the management of hepatocellular carcinoma

Hippokratia 2004, 8(3):99-106

G. Imvrios
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece


Hepatocellular carcinoma (HCC) represents more than 5% of all cancers worldwide. The management of HCC begins with diagnostic confirmation by radiologic imaging or histology. Currently, the prognosis and choice of treatment are largely based on the crude parameters staging,- extent of tumor growth and the presence of vascular invasion-, and the functional state of the liver. Surgery in the form of either hepatic resection or orthotopic liver transplantation, is the only potentially curative treatment and in carefully selected patients with HCC, good results can be obtained from both methods. Transarterial chemoembolization is commonly used as either palliative treatment or adjunctive therapy to surgery. Local ablative therapy may have curative potential in those patients with sufficiently small lesions and adequate liver function. Systemic chemotherapy has low efficacy and significant complication rate. An increasing number of patients with small HCC and decompensating cirrhosis have a benefit from the clinical application of adult-to-adult living donor liver transplantation. Molecular profiling and genetic analyses of HCC to determine the biologic behavior of the tumor, perhaps is the future prospects for the choice of treatment with more consistent results.