Screening and Management of Hepatocellular Carcinoma: The Australian Perspective

Hepatocellular cancer (HCC) remains relatively uncommon in Australia, however incidence rates have been progressively rising, as in many other western countries, over the last few decades. Currently, chronic hepatitis B (HBV) or hepatitis C (HCV) infections accounts for the majority of primary liver cancers, but as the incidence of HBV declines with the implementation of immunization programs and HCV is eradicated by direct acting anti viral therapies, more cases will be due to metabolic causes such as non-alcoholic fatty liver disease. The cornerstone of management involves identifying potential risk factors and implementing both preventative and therapeutic strategies. As we gain more knowledge about the pathogenesis of HCC, newer agents such as multikinase inhibtors have been developed to target specific pathways and have been shown to delay time to disease progression. Well defined screening, diagnostic and management algorithms will allow for standardisation of protocols and enable classification of patients and treatment modalities offering some prediction of outcome and prognosis. It is anticipated that effective screening and surveillance programs will enable the detection of tumours at an early stage thereby allowing for a wider range of therapeutic options with improved outcomes.