Hepatocellular carcinoma: update on diagnosis and treatment.

In this review, the current approach to the screening, diagnostic evaluation, staging, and treatment for hepatocellular carcinoma (HCC) is outlined. The serum alpha-fetoprotein (AFP) level and abdominal ultrasonography (US) remain the cornerstones of screening protocols for HCC. Other serum marker proteins, such as abnormal serum prothrombin (PIVKA-II), when used in conjunction with AFP, can increase the yield for HCC. For diagnosis and staging of HCC, other imaging modalities employed include CT scan, infusion hepatic angiography, CT with arterial portography or iodized oil enhancement, MRI with contrast enhancement, intraoperative US, and US-guided fine-needle aspiration cytology and biopsy. Treatment options which have afforded some improvement in survival and tumor regression include surgical resection, orthotopic liver transplantation, percutaneous injection of ethanol, arterial chemoembolization, cryotherapy, and systemic or regional chemotherapy. Despite these advances, the diagnosis of HCC still portends a dismal prognosis.