Recent research progress in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is responsible for significant morbidity and mortality throughout the world, and is clearly linked to viral infections. Mass vaccination programs against hepatitis B virus have reduced the incidence of HCC in Taiwanese children, and are likely to yield similar benefits elsewhere. In many countries, a definite increase in the incidence of HCC has been reported, largely attributable to the increasing incidence of hepatitis C virus infection. Although the major viral and environmental risk factors for the development of HCC have been determined, the oncogenic pathways leading to malignant transformation of liver cells have long remained obscure. HCC is also extremely difficult to manage. Although patients at risk can be identified and early detection of HCC is feasible, the current management of HCC is confusing due to the lack of well-designed, randomized clinical trials comparing various treatment modalities. New surgical techniques and postoperative therapies may improve the outcome in some resectable cancers; however, the vast majority of patients have unresectable tumors. Local ablation treatments may shrink or necrose tumors, but the clear benefit of such therapies remains to be seen. Further elucidation of the genetic and molecular features of HCC may lend insight that will lead to the development of innovative strategies to manage this cancer. In this article, the current understanding of HCC with respect to etiologic factors, genetic mechanisms responsible for hepatocarcinogenesis, diagnosis, therapy, and prevention are reviewed.