Updates on the staging and treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is an aggressive cancer with an incidence rate of 5 per 100,000 in the United States The incidence of HCC is rising in the United States, owing to a corresponding increase in cirrhosis and viral hepatitis. Even though different staging systems are used, each with certain limitations, the American Hepato-Pancreato-Biliary Association/American Joint Committee on Cancer consensus conference on HCC in 2010 recommended using the Barcelona Clinic Liver Cancer classification for patients with advanced liver disease who might not be surgical candidates and American Joint Committee on Cancer TNM (tumor, node, metastasis) classification for patients who will undergo liver resection or transplant. Treatment options currently include surgical options (e.g., nodular resection or liver transplantation), ablative therapies (e.g., radiofrequency ablation or ethanol injection), catheter-based therapies (chemoembolization or radioembolization), radiation treatment such as stereotactic body radiotherapy (SBRT), or systemic therapy (the multikinase inhibitor sorafenib). Underlying liver dysfunction rather than tumor extent is a more critical limiting factor for many patients who are being considered for surgical options. Curative therapies include surgical options and ablative therapies. Therapies such as catheter-based therapies, SBRT, and sorafenib are not curative but help control the disease or are used as a bridging therapy. Multidisciplinary care involving hepatologists, interventional radiologists, pathologists, radiation oncologists, surgeons, and medical oncologists is paramount in caring for patients with HCC.