With the current practice of surveillance programs in high-risk patients, early stage
hepatocellular carcinoma HCC is commonly diagnosed. This poses great challenge to clinicians, in terms of prognostic estimation, patient stratification to various treatment modalities and patient management during long-term follow-up. This review focuses on the current trends in the management of HCC, with special attention to
tumor staging, treatment algorithm, and outcome of various treatment modalities. According to the American Association for the Study of
Liver Diseases AASLD practice guideline, Barcelona Clinic
Liver Cancer BCLC staging system has fulfilled the criteria that HCC patients can be stratified into different prognostic subgroups, to which optimal treatments can be offered. Under this management scheme, curative treatments hepatic resection,
liver transplantation, and percutaneous ablation would be reserved to the subgroup of patients with relatively good prognosis. For patients with advanced
malignancy localized to the liver, local ablation or transarterial chemoembolization TACE may offer effective symptomatic palliation, and prolongation of patients' survival. For patients with distant
metastases, no effective
therapy can be offered, and symptomatic
palliative care is the best option. Until now, favorable survival outcomes have been reported following hepatic resection,
liver transplantation, and local ablation for HCC. Although the
therapeutic effect of TACE is less pronounced than curative treatments, randomized controlled studies have proven its survival benefit for HCC patients. A comprehensive treatment algorithm involving these treatment modalities is mandatory to ensure optimal care of patients with HCC.