Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the leading cause of death among cirrhotic patients and ranks third in cancer-related mortality worldwide (1). HCC usually develops as a consequence of chronic exposure to various environmental risk factors, including chronic hepatitis B and C viral infection, alcohol consumption, aflatoxin B1 intake from contaminated food, and other agents causing liver cirrhosis (2). Hepatitis B virus (HBV) vaccination has successfully decreased the incidence of HCC cases in Asia (3), but the increase in hepatitis C virus (HCV)-related liver disease has led to an increment of HCC in Western countries (4). Treatment considerations are often complicated by the co-existence of liver cirrhosis. Thus, an accurate assessment of tumor progression and liver dysfunction determines patient prognosis and drives treatment strategy, according to the widely accepted Barcelona-Clínic Liver Cancer (BCLC; 5,6) staging system. This therapeutic algorithm is endorsed by the American and European Association for the study of the liver in their clinical management guidelines (7,8).