Hepatocellular carcinoma - Current management and treatment

Hepatocellular carcinoma (HCC) is the commonest cancer in the world. Its incidence shows marked geographical, within country and ethnic variations. It may be asymptomatic, but the commonest symptoms are abdominal distension, discomfort and weight loss. The only curative treatment is surgery but this treatment is only appropriate in about 10 to 15% of patients. The overall operative mortality range from 3 to 11%. The 5-year survival of HCC after surgical resection for lesions that are less than 5 cm in diameter is around 40%. Systemic chemotherapy has very little impact on patients' survival. The results of treatment with either transarterial embolization (TAE) or TAE with chemotherapy (chemoembolization) are mixed. Percutaneous injection of ethanol appears to be effective in causing tumour necrosis in small HCC. Orthotopic liver transplantation for inoperable symptomatic HCC gives poor results. Screening of at risk group to detect early lesions and the prevention of HCC by vaccination against hepatitis B virus are the measures which may have significant impact on the clinical outcome of patients with HCC.