Hepatocellular carcinoma treatment strategies - a case-based review

Abstract

Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide and one of the fastest growing causes of cancer-related mortality, being mostly diagnosed in patients with cirrhosis. Despite the recent efforts regarding an earlier diagnosis, the majority of patients are at advanced stages at first presentation, when the potential for institution of curative strategies is scarce. This tumor is remarkable because it occurs mostly superimposed on chronic liver diseases, which entails the need to take special attention to liver function preservation and hepatotoxicity prevention when choosing a specific therapy. Major changes had occurred in the management of HCC in the last decade. The decision-making process must be based on an accurate staging of the patient, using the Barcelona Clinic Liver Cancer (BCLC) staging system, updated knowledge of the new therapeutic options, their contraindications and the potential local or systemic complications. The authors start from 4 clinical different scenarios, in order to objectively discuss the therapeutic options available and the decision-making-process based on the staging system.