Hepatocellular Carcinoma:

A review

Laurentius Nico
Yohanes Santoso
Overview
• Introduction

• Risk factor

• Screening

• Diagnosis

• Staging

• Treatment

• Conclusion
Hepatocellular Carcinoma
• An aggressive cancer that occurs in the setting of chronic liver disease and
cirrhosis that frequently presents in advanced stages

• The most common primary liver malignancy and is a leading cause of cancer-
related death worldwide

• Males : females = 2.4 : 1

• Higher incidence in Eastern and Southern Asia, Middle and Western Africa,
Melanesia, and Micronesia/Polynesia

• Can be prevented with HBV vaccination, universal screening of blood

products, treatment and education of alcoholics, etc
Risk factor
• Chronic liver disease

• Cirrhosis

• Viral hepatitis

• Excessive alcohol intake

• Chronic viral hepatitis (Hepatitis B and C)

• Diabetes mellitus

• Obesity
Screening
Early ● Radiographic tests
screening ○ Ultrasonography (US)
○ Multiphase computerized tomography
(CT)
Multiple ○ Magnetic resonance imaging (MRI)
treatment
options ● Serological biomarker
○ α-fetoprotein (AFP)
○ des-γ-carboxy prothrombin (DCP)
Better
outcomes
Diagnosis
• Early diagnosis is the key for better treatment!

• Nodules:
• <1 cm via ultrasonography (US), but cannot be defined → repeat in 3-4 months

• >1 cm via US → radiologic investigation including either contrast-enhanced triple

or quadriphasic CT or MRI

• First radiologic test is equivocal → confirm with different technique

• Serum AFP level >400 ng/mL has a high positive predictive value

• Percutaneous biopsy (limited to those nodules that are radiologically nontypical on

CT or MRI for HCC)
Staging
Treatment
• Systemic therapy • Transarterial chemoembolization

• Transarterial radiation
• Surgical approaches
• Percutaneous local ablation
• Resection
• Microwave ablation
• Liver transplantation

• Nonsurgical approaches
Conclusion

• Continued improvement in both surgical and nonsurgical approaches has

demonstrated significant benefits in overall survival

• Orthotopic liver transplantation (OLT) is the only curative surgical procedure

• Sorafenib has shown to be a unique neoantigenic targeting agent with

encouraging results

• Further investigation about biomarkers both alone and in conjunction with

other modalities to assess survival and tumor regression needs to be
conducted