Decision allocation making depends on cancer staging (early, intermediate and advanced stage)
-Surgery: Surgical resection for early diagnosed liver cancer without extra hepatic extension.
-Liver transplantation: Option for small tumors without extra hepatic extension.
Transplantation of a liver portion or of a whole liver
-Thermal destruction: With ultrasound guidance, we insert probes through the liver tissue near the tumor. This probe delivers high frequency alternating electrical current precisely at the site of the tumor. Cryoablation under the guidance of many imaging methods can induce ice ball formation and tumor necrosis
-Transarterial chemoembolization(TACE) is a minimally invasive technique treatment that is performed in an operating room by an interventional radiologist. It consists of a selective and targeted therapy enabling both the injection of anti-cancer drug into the tumor and stopping the tumor blood flow leading to the lesion shrinkage over the time. During TACE, X-ray guidance is used to navigate a delivery tool (microcatheter) into the hepatic arteries, via a pinhole in the wrist or groin
-Chemotherapy intravenous or oral route. There are two classes of chemotherapy TKI
(tyrosine kinase inhibitor) and immune therapies
-Radiation therapy: external (SBRT) or internal (SIRT)
Source: EASL-EORTC Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma. J. Hepatol. 2018