Epidemiology, Diagnosis, and Non-Pharmacological Treatment of HCC

ABSTRACT: Hepatocellular carcinoma (HCC) is still one of the most common tumors, ranking first among all cancers in relation to its frequency and mortality. Only very recently has there been a deceleration in the incidence and mortality of this neoplasia, which suggests that we may be close to the peak of the HCC epidemic, at least in the Western population. Risk factors are well known, and the hepatitis B and hepatitis C viruses are the main etiologic factors. Indeed, liver cirrhosis (LC) of any etiology is the main cause of predisposition to the neoplastic degeneration of the liver; an underlying LC is present in most cases of HCC. For this reason, a surveillance program has been established by the main associations for the study of the liver, and an ultrasound examination of the liver every 6 months has been codified as a recommendation to facilitate discovery of a neoplastic lesion at an early stage, which allows patients the opportunity to access more efficacious treatments. The actual therapy, in fact, is based on the stratification of patients according to the number of lesions, diameter of the lesions, and the evaluation of the underlying liver cirrhosis and general conditions. According to this (prevalently physical) stratification, patients are allocated to receive liver transplantation, resection, or ablative therapy of the lesion if they are at an early stage. Transarterial chemoembolization is indicated for patients at an intermediate stage, and systemic therapy with sorafenib is recommended only for advanced tumors. The prognosis of HCC is being ameliorated in time with a better selection of patients and with a better performance of the therapeutic equipment; however, current efforts should be directed toward the primary prevention of cirrhosis, together with the very early diagnosis of HCC. In this respect, it seems that with the spreading of hepatitis B virus (HBV) vaccination in highly endemic countries and with the treatments of hepatitis C virus (HCV) with the new direct-acting antiviral drugs, both the HCC frequency and mortality will decrease in the near future.