Skip to main content
SpringerLink
Log in

Hepatocellular Carcinoma

  • Chapter
  • First Online:
Surgical Oncology Manual

  • 831 Accesses

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver and its incidence is growing. Most HCCs arise in cirrhotic livers and the treatment options depend on the tumor stage as well as the underlying liver function. Liver resection is usually offered to patients with solitary tumors and well-preserved liver function, while liver transplantation represents the best treatment option for those patients with decompensated cirrhosis and/or multifocal disease, within established guidelines. Other locoregional treatment options such as ablation, including radiofrequency ablation (RFA) or microwave ablation (MWA), transarterial chemoembolization (TACE), transarterial radioembolization (TARE with Y90) and stereotactic body radiation, may also be applied in various clinical scenarios. Systemic treatment for unresectable HCC has largely been limited to sorafenib. However, recent results have demonstrated that levatinib is an equivalent first-line treatment, and several agents have demonstrated efficacy as second-line agents for patients who progress on sorafenib. Checkpoint inhibitors still remain on the horizon with no clear supporting data for their use. In this chapter, we review the current state of the art for the management of HCC.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Forner A, Reig M, Bruix J. Hepatocellular carcinomas. Lancet. 2018;391:1301–14.

    Article  Google Scholar 

  2. Globocan. Liver cancer worldwide: Globocan 2018 Report. 2018;876:2018–2019.

    Google Scholar 

  3. Cancer facts and figures. 2019. Available at: www.cancer.org.

  4. Canadian Cancer Statistics. Canadian Cancer Society’s Steering Committee on Cancer Statistics. 2018.

    Google Scholar 

  5. Vauthey JN, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20:1527–36.

    Article  Google Scholar 

  6. Burkhart RA, Pawlik TM. Staging and prognostic models for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control. 2017;24:1–11.

    Article  Google Scholar 

  7. Livraghi T, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–9.

    Article  Google Scholar 

  8. Maithel SK, et al. Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis. J Am Coll Surg. 2011;212:638–48.

    Article  Google Scholar 

  9. Sapisochin G, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study. Hepatology. 2016;64:2077–88.

    Article  Google Scholar 

  10. Mulier S, et al. Local recurrence after hepatic radiofrequency coagulation. Ann Surg. 2005;242:158–71.

    Article  Google Scholar 

  11. Chen M-S, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243:321–8.

    Article  Google Scholar 

  12. Zhou Y, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol. 2010;10:78.

    Article  Google Scholar 

  13. Wang Y, et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS One. 2014;9:e84484.

    Article  Google Scholar 

  14. Llovet JM, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359:1734–9.

    Article  Google Scholar 

  15. Lo CM, et al. Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164–71.

    Article  CAS  Google Scholar 

  16. Yoong BK, et al. SIRveNIB: selective internal radiation therapy versus Sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol. 2018;36:1913–21.

    Article  Google Scholar 

  17. Vilgrain V, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol. 2017;18:1624–36.

    Article  CAS  Google Scholar 

  18. Salem R, et al. Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2016;151:1155–1163.e2.

    Article  Google Scholar 

  19. Liau K-H, et al. Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma. Cancer. 2005;104:1948–55.

    Article  Google Scholar 

  20. Kim PTW, et al. Outcomes after hepatic resection and subsequent multimodal treatment of recurrence for multifocal hepatocellular carcinoma. Br J Surg. 2013;100:1516–22.

    Article  CAS  Google Scholar 

  21. Roayaie S, et al. Resection of hepatocellular cancer ≤2 cm: results from two Western centers. Hepatology. 2013;57:1426–35.

    Article  Google Scholar 

  22. Shi M, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.

    Article  Google Scholar 

  23. Mazzaferro V, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.

    Article  CAS  Google Scholar 

  24. Yao FY, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33:1394–403.

    Article  CAS  Google Scholar 

  25. Llovet JM, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.

    Article  CAS  Google Scholar 

  26. Kudo M, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018;391:1163–73.

    Article  CAS  Google Scholar 

  27. Bruix J, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389:56–66.

    Article  CAS  Google Scholar 

  28. Cicin I, et al. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med. 2018;379:54–63.

    Article  Google Scholar 

  29. Zhu AX, et al. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased α-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20:282–96.

    Article  CAS  Google Scholar 

  30. Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.

    Article  Google Scholar 

  31. Galle PR, et al. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.

    Article  Google Scholar 

  32. Clavien P-A, et al. Recommendations for liver transplantation for hepatocellular scarcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abdominal Organ Transplant and Hepatopancreatobiliary Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Blayne Amir Sayed, Paul D. Greig & Gonzalo Sapisochin

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Shiva Jayaraman & Calvin H. L. Law

  3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Alice C. Wei

Authors
  1. Blayne Amir Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiva Jayaraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Calvin H. L. Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alice C. Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul D. Greig
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gonzalo Sapisochin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gonzalo Sapisochin .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Frances C. Wright

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Jaime M. Escallon

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Moises Cukier

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Melanie E. Tsang

  5. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Usmaan Hameed

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sayed, B.A., Jayaraman, S., Law, C.H.L., Wei, A.C., Greig, P.D., Sapisochin, G. (2020). Hepatocellular Carcinoma. In: Wright, F., Escallon, J., Cukier, M., Tsang, M., Hameed, U. (eds) Surgical Oncology Manual. Springer, Cham. https://doi.org/10.1007/978-3-030-48363-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48363-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48362-3

  • Online ISBN: 978-3-030-48363-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation