
DIAGNOSIS
Hepatocellular carcinoma (HCC) is usually diagnosed through screening program to detect early HCC using ultrasounds every 6 months in people with cirrhosis. Once a lesion has been identified, the diagnosis of HCC is made on the presence of characteristic features of an HCC using dynamic imaging tests such as CT and MRI with contrast that should confirm the diagnosis in a patient deemed to be at risk of the disease.
Patients diagnosed with HCC should be managed by a multidisciplinary team involving hepatologists, surgeons, radiologists (including interventional radiologists), pathologists, and oncologists. Multidisciplinary expert care can improve outcomes for patients with HCC.
PREVENTION
Primary prevention focus on risk factors for HCC and their treatments. To prevent the complications of chronic HBV infection, the World Health Organization (WHO) recommends to include hepatitis B vaccination in routine immunization services in all countries. Another essential strategy to prevent HCC related to chronic viral hepatitis is testing blood products for HBV and HCV, as well as adoption of universal precautions to avoid transmission of blood-born viruses in healthcare settings. Chronic Alcoholic Liver Disease (ALD) has become one of the leading risk factors for HCC with the special challenge as these patients are frequently missed by surveillance programs, resulting in advanced tumor stages at the time of diagnosis. Early diagnosis of ALD is important to encourage alcohol abstinence to minimize the progression of liver fibrosis, and manage cirrhosis-related complications including HCC. NAFLD/NASH are considered to be caused by the “western” lifestyle, such as unhealthy diet and sedentary culture. To reduce risk of non-alcoholic fatty liver disease it is advised to adopt a healthy diet rich in fruits, vegetables, whole grains and healthy fats, exercise regularly and maintain a healthy weight. This lifestyle intervention may serve as HCC prevention. HCC surveillance enables early detection and increases the chance of potentially curative treatment; therefore, broad implementation of HCC surveillance in high-risk patients is essential to reduce the high mortality from HCC.
Hepatocellular carcinoma (HCC)
Hepatocellular carcinoma (HCC) is one of and also the most common type of liver cancer. Other types of liver cancer – intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common. HCC is considered to be one of the leading causes of cancer-related deaths worldwide. It is associated with liver cirrhosis in western populations, but can occur in non-cirrhotic liver tissue, especially in eastern populations with hepatitis B virus (HBV) infection.
POSSIBLE SYMPTOMS
Most people don’t exhibit symptoms in the early stages of HCC. However, when signs and symptoms do appear, they might be related to cancer or to chronic liver disease.
RISK FACTORS
The risk of hepatocellular carcinoma is higher in people with cirrhosis caused by infection with HBV, HCV, alcohol abuse or accumulation of fat in the liver (NAFLD/NASH). Chronic liver disease due to HBV or HCV or alcohol accounts for the majority of HCC cases, whilst the incidence of non-alcoholic fatty liver disease, has been rising and it is also associated with the development of HCC.

SURVEILLANCE
The decision to enter a patient into a surveillance programme is determined by: The risk of having HCC Always considering different factors in each case (age, co-morbidities etc.) Surveillance is recommended for: Patients with cirrhosis (irrespective of the etiology) Patients with hepatitis B but no cirrhosis, in whom the annual incidence of HCC is more than 0,2% Preferred test for surveillance is ultrasonography and screening of patients is recommended every 6 months.
PROGNOSTIC MODELS AND HCC STRATIFICATION

CURRENT TREATMENT MODALITIES
THE ROLE OF LIVER PATIENTS' ASSOCIATIONS
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