Abstract

• Hepatocellular carcinoma (HCC) is effectively a wide range of diseases, occurring in a wide range of underlying liver diseases. The combination of these problems requires attention to details of tumor location, extent and anatomy, as well as attention to subtleties of liver function limitations and variable causes of the underlying liver diseases.

• Most patients have competing causes of death - HCC and underlying liver disease- and treatment of the cancer is impacted by existing liver disease/dysfunction.

• Given the wide range of etiologies and underlying liver conditions, presentation canvary from an incidental finding, to a fever, to mass effect of massive tumor, to signs of liver dysfunction, to paraneoplastic syndromes.

• Several staging systems for HCC take into account tumor factors and liver factors relevant to prognosis among candidates for treatment and those best treated with supportive care.

• Among interventional therapies, intra-arterial therapies, percutaneous ablative therapies, and more aggressive potentially curative therapies (partial hepatectomy or liver transplantation) reflect the wide range of presentations and problems with small tumors in advanced liver disease patients vs. extensive cancer in patients with preserved underlying liver function.

• Proper management of HCC patients thus requires deep and expansive multi- and inter-disciplinary care designed to apply the best options to individual patients.