Prospects and Unmet Needs of HCC Management

Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults. A significant proportion of HCC cases arise in individuals with cirrhosis caused by hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. These infections are especially widespread in low- and middle-income countries (LMICs), making the prevention, early detection, and treatment of HCC particularly challenging in resource-limited settings. Many patients in these regions present at advanced stages of the disease, often with impaired liver function due to underlying chronic liver conditions, resulting in poor treatment outcomes despite available therapies. Recent advancements have improved early detection techniques and expanded treatment options for HCC. Approvals of new therapies for advanced stage disease have extended patient survival and enhanced quality of life through better symptom management. However, significant barriers to effective HCC management remain. Challenges in screening and diagnosis include the silent nature of early-stage disease, limited healthcare infrastructure, and financial barriers to accessing diagnostic services, particularly in LMICs. Educational barriers are also evident, stemming from both patient illiteracy and gaps in healthcare provider training. Treatment-related obstacles involve selecting the appropriate therapeutic approach based on disease stage and liver function, ensuring patient acceptance of treatment plans, and securing access to necessary therapies and specialist expertise, issues that are more pronounced in resource-constrained environments. Overcoming these challenges, alongside addressing other unmet needs, isessential for optimizing HCC care. This chapter aims to explore current and emerging strategies for HCC diagnosis and treatment, with a particular focus on addressing gaps in care in low- and middle-income countries.