Paul H Hayashi MD Adrian M Di Bisceglie MD

Division of Gastroenterology and Hepatology, Department of Internal Medicine,

Saint Louis University Liver Center, 3635 Vista Avenue, St. Louis, MO 63110-0250, USA

Patients with, or at risk for, hepatocellular carcinoma (HCC) present special challenges to the clinician. Despite improved understanding of HCC, current guidelines and treatment algorithms are still inadequate. The gastroenterologist or primary care physician may provide screening and prevention, but clinical care after HCC has occurred is a specialized task. A multidisciplinary team including a hepatologist, oncologist, transplant surgeon, interventional radiologist, and liver histopathologist may be needed. Team coordination and expertise is highly important, and most available at tertiary care referral centers. In this article, some of the challenging and controversial issues regarding HCC detection, diagnosis, prevention, and care are reviewed, with particular emphasis on hepatitis B- and C-associated HCC. Although not always evidenced-based, practice guidelines or standard of care practices are summarized.

Clinical presentation

The clinical presentation of HCC ranges from catastrophic tumor rupture into the peritoneum to incidental cancer diagnosed by abdominal imaging.

A version of this article originally appeared in the 89:2 issue of The Medical Clinics of North America.

* Corresponding author.

E-mail address: [email protected] (P.H. Hayashi).

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