Clinical presentation and natural course of hepatocellular carcinoma.

The natural history of hepatocellular carcinoma has evolved considerably over past decades. Patient presentation is highly dependent on the severity of underlying hepatic function, although many patients are now diagnosed by screening programmes prior to the development of symptoms. Growth and maturation of hepatocellular carcinoma is variable and involves a complex network of hepatic vasculature. Staging systems have been developed to predict disease progression and survival and continue to undergo investigation.