Management of Hepatocellular Carcinoma: an update at the Start of 2014

Background: Over the past 15 years, the incidence of hepatocellular carcinoma [HCC] has more than doubled.Materials and methods: A search of the literature was made using cancer literature and the PubMed, Scopus,and Web of Science [WOS] database for the following keywords: “hepatocellular carcinoma”, “molecularhepatocarcinogenesis”, “RFA”, “TACE”, “TABE”, “OLTx”, “targeted therapy”, “sorafenib”, “sunitinib”, “tivantinib”,“antiangiogenic” “drugs”, “immunotherapy”.Discussion and conclusion: For a correct and effective treatment strategy in patients with cirrhosis, it isnecessary to perform a liver ultrasound twice a year. With the recent dramatic advances in diagnostic modalities, thediagnosis of HCC is primarily based on imaging. Ultrasound plays a crucial role in HCC surveillance, dynamicmultiphasic multidetector-row CT [MDCT] and magnetic resonance imaging [MRI] are the standard diagnosticmethods for the noninvasive diagnosis of HCC. Treatment decisions are complex and dependent upon tumorstaging, presence of portal hypertension and the underlying degree of liver dysfunction, as well as local expertise, asindicated by the NCCN, APASL, AASLD, BCLC,EASL. Unfortunately, HCC is diagnosed at an advanced stage. Inthis case the therapeutic option is the systemic therapy. The knowledge of molecular hepatocarcinogenesisbroadened the horizon for patients with advanced HCC. During the last years several molecular targeted agentshave been evaluated in clinical trials in advanced HCC. In the future new therapeutic options will be represented bya blend of immunotherapy-like vaccines and T-cell modulators, supplemented by molecularly targeted inhibitors oftumor signaling pathways. Thus, it will be necessary in the future to classify HCCs into subgroups according to theirgenomic and proteomic profiling. The identification of the key molecules/receptors/signaling pathways and theassessment of their relevance as potential targets will be the main future challenge. Defining molecular targetedagents effecttive for a specific subgroup will hopefully lead to personalized therapy.