Hepatocellular Carcinoma (HCC): An Update with Reference to Diagnosis and Treatment

Four-phase multidetector CT or dynamic contrast-enhanced MRI are two non-invasive tests that can be used to provide a definitive diagnosis.

By Wafa Majeed٭1,2, Muhammad Saad Tariq1

Introduction:

Cancer is the root cause of death worldwide. Hepatic cancer is the sixth most widespread cancer with a low 5-year survival rate of 7%. The geographic prevalence of viral hepatitis corresponds to the geographic incidence of liver cancer. Hepatocellular carcinoma is the predominant liver cancer in adults that causes most of the mortality in emerging countries (HCC).  

Diagnosis:

A diagnosis of HCC is confirmed by the existence of a venous or prolonged phase washout of contrast medium, arterial hyper-enhancement is achieved. While MRI has better contrast resolution than CT, it is limited by metallic implants, respiratory artifacts, substantial ascites, expense, and availability. Patients who have unusual HCC characteristics on CT or MRI should have another imaging mode or a lesion biopsy. A liver biopsy should be performed on anyone who has hepatic lesions without cirrhosis. The imaging modalities indicated above can be used by cirrhotic patients or persistent HBV despite cirrhosis. Because contrast-enhanced ultrasonography lacks specificity for HCC, it should not be used for diagnosis. Unfortunately, biopsies have a high probability of false negatives (up to 30%) due to insufficient samples. To diagnose HCC, a multidisciplinary approach is used that incorporates clinical, radiographic, and laboratory modalities, as well as liver biopsy (in some cases).

Modern Diagnosis:

CRISPR:

Gene editing is being revolutionized. Researchers never imagined being able to alter the genetic code of living cells speedily and instantly. It acts like a pair of scissors, deleting, inserting, or editing specific sections of DNA inside cells with pinpoint accuracy.

Artificial Intelligence:

Computer programming is utilized to improve cancer diagnosis, drug development, and precision medicine. Programming a machine to act, think, and learn is what artificial intelligence is all about. It excels at finding patterns in enormous volumes of data, which is especially useful in scientific studies.

Telehealth:

Many hospitals and clinics across the country are adopting telehealth for remote health monitoring, video visits, and even in-home chemotherapy to improve patient safety and convenience. Even during the COVID-19 pandemic, many of the participating health-care organizations effectively implemented or extended telehealth techniques to provide cancer treatment and care to patients remotely.

Infinium Assay:

It is a toolkit for analyzing millions of single nucleotide polymorphisms, or SNPs, which are the most frequent type of genetic variation. SNPs can aid in the mapping of cancer-causing genes and provide information on cancer risk, progression, and development.

Staging Systems in Hepatocellular carcinoma:

It has been proposed that effective HCC staging systems contain four factors: tumor stage, degree of liver function impairment, the overall health of the patient, and therapy efficacy. Prognostic systems that only consider one of these factors (CTP, TNM, or performance status) are only somewhat useful.

Five new approaches have recently been developed to address these challenges and provide an effective tumor classification. The majority of these classifications, on the other hand, were created with patients in advanced tumor stages, which helps to explain why all patients at apparently early stages had miserable results. There is presently no universally approved HCC classification.

Several methodologies have been developed for predictive staging and decision-making in HCC patients: Child-Pugh, MELD, TNM classification, tumor volume estimation, and ECOG (evaluation of the patient’s performance status) are all one-dimensional assessments. The most widely used categorization is a multidimensional technique created by the Barcelona Clinic Liver Cancer group. This technique has been proven in a variety of settings, with suggestions for each stage of the disease. Very early stage (0), Early-stage (BCLC A), Intermediate stage (BCLC B), Advanced stage (BCLC C), Terminal stage (BCLC D), Molecular classification.

Treatment:

  1. Chemotherapy:

Although various molecular pathways have been implicated in the etiology of HCC, only a few therapeutic strategies that are specifically aimed at these molecular targets have proven to be effective; the most deliberate and justified is the use of sorafenib. This drug inhibits the serine-threonine kinases Raaf-1 and B-Raaf, as well as VEGFR 1, 3, and 5, and PDGFR-. In phase I studies, sorafenib produced partial responses in a variety of solid tumors, including one case of hepatocarcinoma.

  1. Radiation Therapy:

In radiation therapy X-rays are used to kill cancer cells. Radiation come outside the body called external radiation. Radiation placed inside the body is called Brachytherapy.

  • Surgical Treatment:
  1. Liver resection:

The decision to resect the liver is based on three factors: the size of the tumor, tumor location of the tumor, and liver function. In patients with solitary liver tumors, without radiological evidence of vasculitis, and normal liver performance, the treatment of choice is only the resection.

  1. Liver transplant:

It is thought to be the most effective therapy for HCC patients with cirrhosis since it removes the tumor and treats the preneoplastic state. In the 1990s, patients with a single HCC less than 5 cm in diameter or three or fewer nodules less than 3 cm in diameter and no extrahepatic or vascular dissemination were identified as suitable candidates for liver transplantation.

  1. Loco-regional treatments:

Patients with the Hepatocellular carcinoma are treated with locoregional therapy according to the oncological stage, degree of performance, and related liver disease.

  1. Combined treatment:

Chemoembolization coupled with radiofrequency has already been proven to effectively restrict cancer growth in 3 to 5 cm lesions. One of the advantages of combination therapy is that the hypoxia only from embolization and the effects of the chemotherapeutic drugs act together to diminish the tumor’s blood flow. After chemoembolization, a breakdown of the intra-tumoral septa may enhance heat distribution inside the tumor and reduce reperfusion-mediated organ cooling, which results in a larger zone. Within 14 days, selective chemoembolization should be performed first, accompanied by radiofrequency ablation.

  1. Immunotherapy:

It is also called biological therapy. The body’s immune system is used to fight against cancer. Cancer is unchecked in the body because the body’s immune system could not recognize it. Immunotherapy helps the immune system to see cancer cells and attacks the cells.

  • Hormone Therapy:

Many cancers can use body hormones as fuel. E.g., breast and prostate cancers. Removing those hormones from the body or blocking the effects may cause cancer cells to stop developing.

  • Cryoablation:

It is the treatment that kills the cancer cells through the cold. A cryoprobe (wand-like needle) is used through the skin and is inserted into the tumor. Gas is pumped to freeze the tissue. Allow the tissue to thaw. Repeated thawing and freezing several times in order to remove cancer cells within the same therapy session.

Wafa Majeed٭1,2, Muhammad Saad Tariq1

1Department of Pharmacy, University of Agriculture, Faisalabad, Pakistan

2Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan

Corresponding Author:

٭Wafa Majeed