Diagnosis and Management of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. This entity typically presents in middle-aged males and is related to the presence of HBV and HCV infection. Patients will often present with weight loss, lethargy, and right upper quadrant pain which prompt workup with routine laboratory studies including a liver function panel, as well as an ultrasound or dedicated liver imaging with a computed tomography (CT) or magnetic resonance imaging (MRI). Once HCC is identified, staging of the disease and workup of liver function is essential to determining the appropriate course of action. Extrahepatic metastasis excludes patients from resection. If not metastatic, tumor burden as well as the patient’s Child-Pugh classification is imperative to determine resectability. Many locoregional therapies exist (radiofrequency ablation (RFA), transarterial chemoembolization (TACE), yttrium-90) for complex patients who may not be eligible for resection or transplantation. Finally, patients with unresectable disease due to underlying severe liver dysfunction are treated with orthotopic liver transplantation if they are within the established Milan criteria.