Hepatocellular Carcinoma

Hepatocellular carcinoma has become a relevant clinical problem in all units responsible for the management of patients with liver diseases. Several years ago this neoplasm was seen as a very infrequent disease that almost exclusively affected some countries in Asia and Africa, while it was regarded as uncommon in Western countries. In addition, it was usually stated that detection at an early stage was unfeasible, at least in the West, and that treatment was of no benefit.

These statements have all proved to be wrong. The incidence of liver cancer has significantly increased in several Western countries, development of liver cancer is now the leading cause of death in patients with cirrhosis, early detection is feasible through expert ultrasound screening, and several effective treatment options are available. In that sense, although until very recently the single treatment approach was surgical resection, now the therapy portfolio with a demonstrated positive impact on survival includes liver transplantation, percutaneous or laparoscopic ablation by several techniques, and transarterial chemoembolization.

These developments have prompted the wide implementation of screening programs in cirrhotic patients, led to the need to stage the patients accurately according to tumor extent and life expectancy, and ultimately triggered a major controversy about which should be the optimal treatment algorithm to follow and to which extent treatment is beneficial in terms of survival.

In the current issue of Seminars in Liver Disease, I have had the pleasure as Guest Editor to assemble a panel of international experts in the field who have summarized the state-of-the-art knowledge regarding hepatocellular carcinoma. The articles review the molecular events leading to cancer, the interventions to prevent the acquisition of the risk factors, the current optimal strategies to achieve early detection of the neoplasm, and the challenges that pathologists and radiologists face to define accurately the benign or malignant nature of hepatic nodules encountered in a cirrhotic liver. Finally, three articles describe the available proposals to stage the patients and predict their prognosis and the efficacy of the surgical and medical options that can be offered to patients diagnosed with this neoplasm.

I am confident that the concepts exposed in the pages that follow will be of major value in providing all those interested in the management of and research on hepatocellular carcinoma with the needed background to guide their current practice but also to understand the advances that will surely occur in the next few years.