Hepatocellular carcinoma (HCC) is the most common primary liver cancer, with increasing prevalence and mortality worldwide. The greatest risk factor for HCC is liver cirrhosis; however, these patients are often asymptomatic, making them difficult to identify for surveillance. Diagnosis is made with contrast-enhanced imaging and/or liver biopsy. HCC is assessed with the validated Barcelona Clinic Liver Cancer staging system, which encompasses tumour size, liver function and patient performance status. HCC without extrahepatic manifestations or vascular invasion may be cured with surgical intervention, involving either partial resection or full resection and liver transplantation. Locoregional therapies include tumour ablation, used for minimally invasive cure of early disease, and transarterial chemo-embolisation (TACE), used for control of intermediate disease. Both ablation and TACE are also used for downstaging as a bridge to transplantation. More advanced HCC can be controlled with drug-based systemic therapies involving either an oral kinase inhibitor (e.g. sorafenib, lenvatinib or regorafenib) or intravenous immunotherapy with one or more monoclonal antibodies (e.g. atezolizumab and bevacizumab). Best outcomes in HCC management require a multidisciplinary approach, including nutritional support and palliative care. The clinical nurse specialist plays an integral role by co-ordinating the treatment care pathway and responding to patient needs.
Is the Hong Kong Liver Cancer staging system the best guide for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors?