Current Perspectives on Hepatocellular Carcinoma: Summary and Evidence-Based Recommendations

When cancerous cells grow inside the liver's tissues, this is called primary liver cancer. Primary liver cancer is different from metastatic cancer, which starts in another part of the body and spreads to the liver. The liver is one of the body's largest organs. Hepatocellular carcinoma (HCC) can be caused by liver cirrhosis, infections with hepatitis B and C viruses, excessive alcohol consumption, exposure to aflatoxin B1, and non-alcoholic steatohepatitis. Hepatocellular carcinoma is the fifth most common cancer worldwide and the second leading cause of cancer-related deaths. Chronic infections with hepatitis B and C viruses are the primary causes of hepatocellular cancer. About 90% of hepatocellular carcinoma cases occur after chronic liver disease. Cirrhosis of any cause is the main risk factor for HCC. In Asia and Africa, hepatitis B virus infection accounts for 60% of hepatocellular carcinoma cases, while in the West, it accounts for only 20%. Long-term heavy alcohol use can lead to hepatocellular cancer, cirrhosis, and alcoholic liver disease. Genome sequencing studies have identified several genes linked to hepatocellular carcinoma, although most genetic pathways involved are still unknown. There are three main surgical options for HCC: liver transplantation, tumor removal surgery, and tumor removal followed by additional therapy. Sorafenib is a multi-kinase inhibitor that blocks Raf-1 and other tyrosine kinases, which are essential for cell growth, differentiation, and survival. It is the first drug approved for systemic therapy and is the primary treatment for patients with advanced hepatocellular carcinoma who have preserved liver function and are not candidates for transplant or surgery.