Hepatocellular carcinoma: predisposing conditions and precursor lesions

The global incidence of hepatocellular carcinoma (HCC) is rising; in the United States, its rise is in parallel to that of cirrhosis due to the epidemics of hepatitic C virus and obesity. The lack of adequate treatment for advanced HCC mandates both prevention and early detection of these lesions. The limitations of currently available histopathological evaluations, serologic markers, and radiographic imaging modalities in detecting HCC and its precursors have been outlined in this review. Refinements of all of these may lead to better HCC detection, earlier intervention, and successful treatment. Randomized, controlled trials are necessary to evaluate the most efficacious and cost-effective approach to screening.