Liver cancer

Liver cancer is the second most common cause of cancer-related mortality worldwide and is the leading cause of increase cancer mortality in the USA. Most patients are still diagnosed at intermediate-advanced stages, where potentially curative options are not recommended. Patients with liver cancer usually have underlying liver disease: cirrhosis caused by viral hepatitis, alcohol abuse, or fatty liver being the main risk factors. The BCLC staging system is widely accepted as the standard to predict survival and provide treatment recommendations. It classifies patients based on tumor burden, degree of liver dysfunction, and performance status. Curative treatment options include surgical resection, liver transplantation, and local ablation which increase survival rates up to 70% at 5 years. Patients at intermediate stage (multinodular asymptomatic tumors) are recommended to receive chemoembolization. Patients at advanced stages should be evaluated for sorafenib or lenvatinib, and regorafenib, cabozantinib, or ramucirumab (if alpha fetoprotein >400 ng/mL) for patients progressing to sorafenib. Nivolumab was FDA approved in second line based on phase II data.