Hepatocellular Carcinoma (HCC)

 (Hepatocellular Carcinoma (HCC

Dr. Mohamed El-Kassas, Md, D.H.M.

Consultant of Hepatology

Faculty of Medicine Helwan University

Hepatocellular Carcinoma (HCC) is the sixth most common cancer worldwide, accounting for 7% of all cancers and an estimated incidence of 749,000 new cases every year. It is considered to be the third cause of cancer related deaths (692,000 cases). The highest incidence rates of HCC (around 85% of cases) are present in East Asia, sub-Saharan Africa, and Melanesia.

Management of HCC

Management of HCC starts by identifying its stage and underlying liver status then choosing the most appropriate line of therapy (surgical, locoregional, radiological and medical) aiming to improve the survival and/or the quality of life of the patient. For proper assessment, prognosis estimation and treatment decisions.

Clinical staging systems are primarily made to assure well designated guidelines for assessment, prognosis estimation and treatment decisions. For the time being, at least seven different staging systems are present for management of HCC. Each one of these staging systems has its advantages as well as some related defects Proper treatment needs the interaction of multidisciplinary HCC clinic to choose the most appropriate line of treatment. The different modalities of management include resection (surgery or transplantation), local ablation, chemoembolization, radioembolization and molecular targeted therapies with a wide range of investigational drugs that developed after the FDA approved sorafenib. The first successful molecular targeted drug is sorafenib. It is considered the standard systemic therapy for HCC. Sorafenib is an orally administered multikinase inhibitor drug with antiproliferative and antiangiogenic activity. This small molecule multitargeted tyrosine kinase inhibitor (TKI) inhibits vascular endothelial growth fac- tor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR), B-Raf, Fms-related tyrosine kinase (Flt), and c-kit. Its main indication is patients with well-preserved liver

The highest incidence rates of HCC (around 85% of cases) are present in East Asia, sub-Saharan Africa

function (Child-Pugh A class) who have advanced tumors (BCLC C). It is also indicated for tumors progressing on loco-regional therapies Downstaging and bridging are two important strategies to manage HCC patients who will undergo liver transplantation to improve their postoperative survival. In general, Child-Pugh class, serum alpha-fetoprotein, tumor size, portal vein thrombosis, and TNM stage are independent prognostic factors for survival among HCC patients. The outcomes in patients with early tumor stage and Child-Pugh class A or B are significantly better with surgical resection than with other treatment modalities and patients who underwent additional transcatheter arterial chemoembolization (as a second-line treatment) after surgical resection had better outcomes than those who underwent surgical resection alone.