Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this
cancer. Worldwide, HCC is a leading cause of
cancer-related deaths, as it is the fifth most common
cancer and the third most important cause of
cancer related death in men. Among various risk factors the two are prevailing: viral
hepatitis, namely
chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of
obesity and the
metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic
Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the
disease (chronic liver disease and the
cancer) and due to the large number of potentially efficient
therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and
tumor ablation) or palliative (transarterial
therapy, radioembolization and medical treatment, i.e.,
sorafenib) is mandatory to achieve the best treatment outcome.