Early stage hepatocellular carcinoma is best managed by curative treatment
- includes resection, ablation, or transplantation
Hepatic resection is the treatment of choice but the majority of tumours are detected too late for this to be effective.
For inoperable tumours, hepatic transplantation is an alternative. Theoretically, it has the advantage over resection of a lower risk of recurrence from undetected small tumour foci.
Treatment decisions are based on a multidisciplinary discussion on staging and best treatment by hepatologist, transplant and hepatic surgeon, interventional radiologist, radiation oncologist, diagnostic radiologist, pathologist, and palliative care physician. Options are:
Surgical treatment
- liver transplantation
- best curative option for patients with decompensated cirrhosis
- HCC is the only solid cancer that can be treated with transplantation
- surgical resection
- best curative rate with a 5-year survival of 41%–74% (for patients who have a solitary tumour confined to the liver without radiologic evidence of vascular invasion and preserved liver function)
- however, resection is possible in only 25% of patients because of tumour size, location or underlying parenchymal disease.
- local ablation
Locoregional treatment
- embolization of the hepatic artery branch leads to selective tumor hypoxia and eventually tumor necrosis
- hepatic artery is the main arterial supply to the tumour. It may be catheterised percutaneously via the femoral artery and coeliac axis. Embolization occludes those hepatic arterial branches that supply the tumour causing necrosis. It requires a general anaesthetic. Complications include pain, abscess formation, fever and misplaced injections
- transarterial chemoembolization
- transarterial radioembolization
- stereotactic body radiation
Systemic treatment
- multikinase inhibitors
- immune checkpoint inhibitors
- combination treatment
Best palliative care.
Reference:
- Balogh J et al.Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016; 3: 41–53.
- Yang JD, Heimbach JK. New advances in the diagnosis and management of hepatocellular carcinoma.BMJ 2020;371:m3544