Hepatocellular carcinoma: Diagnosis and treatment

Hepatocellular cancer (HCC) is the most common cause of death among patients with liver cirrhosis. Screening programs for high-risk patients allow diagnosis at an early stage, when curative treatment options can be offered. Contrast-enhanced imaging modalities are used for diagnosis, with a typical finding in the respective imaging technique being sufficient to establish the diagnosis for lesions >2 cm. Depending on the imaging results, biopsy for histological confirmation of the diagnosis has to be considered for lesions 1–2 cm in diameter. Lesions <1 cm should be controlled after 3 months. In patients without chronic liver disease, histological confirmation is always required. According to stage-dependent treatment algorithms, surgical options are the primary treatment for early-stage disease (resection, orthotopic liver transplantation). In the case of contraindications, radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) can also be considered. The latter is the treatment modality of choice for intermediate-stage disease in which curative options are no longer available. Further ablative and radiological interventional therapy modalities are under current evaluation in clinical studies, also in combination with systemic therapies. For advanced-stage disease in patients with good liver function, systemic therapy with sorafenib is indicated. Further targeted therapies are currently not available. Data of a phase-III trial that has been recently published as abstract confirm the efficacy of Regorafenib as second line treatment. Additionally new data from international multicentric genome sequencing projects suggest further promising therapeutic targets. An effect of sorafenib in an adjuvant setting could not be confirmed.