Hepatocellular carcinoma

Hepatocellular carcinoma (HCC), one of the serious complications of cirrhosis, is the second leading cause of cancer-related deaths in males worldwide. Besides prevention of HCC development by hepatitis B virus vaccination in endemic regions, early detection is the only effective measure to increase survival and to decrease public health burden. Although HCC is an appropriate type of cancer for conducting surveillance program, the current strategy to detect HCC at early stage using ultrasound and serologic markers is not optimal. Clinical diagnosis of HCC largely depends on the characteristics of hypervascular cancer, and has evolved due to the improvement of imaging techniques including computed tomography scan and magnetic resonance imaging. Staging systems suggested so far have tried to integrate tumor extent, liver function, and patient's performance status to link an available treatment method and predict survival. Further exploration for improved treatement in advanced stage and molecular classification is necessary. Resection and local ablation can achieve cure in small (≤2 cm) HCC, and liver transplantation is effective in that HCC-prone liver is also replaced. Transarterial chemoembolization (TACE) is the most commonly used therapy for multiple HCC, and was found to increase patient survival. New catheter-based treatments such as DC Bead TACE and Yttrium-90 radioembolization have been developed and await long-term results. As an alternative, external beam radiation therapy has s a potent antitumor effect with minimal adverse effect. With the advent of sorafenib, the era of molecular targeted therapy for HCC has begun. In spite of improvement of each treatment modality, a multidisciplinary team approach is mandatory for the optimal HCC management due to the heterogeneity of the cancer and high rate of recurrence. MicroRNA (miR) technology including anti-microRNA (antagomir) and miR-mimetics could be an emerging field of HCC treatment.