The article provides an update on the management of hepatocellular carcinoma (HCC) based on new information since the 2005 American Association for the Study of Liver Diseases (AASLD) practice guidelines. Key changes include: 1. **Surveillance and Diagnosis**: - New data on HCC risk for hepatitis B, C, and autoimmune hepatitis have been identified. - Surveillance is cost-effective if the expected HCC risk exceeds 1.5% per year for hepatitis C and 0.2% per year for hepatitis B. - Alpha-fetoprotein determination is inadequate for effective surveillance; ultrasound examination is recommended with a screening interval of 6 months. - Diagnosis should be based on imaging techniques and/or biopsy, with dynamic imaging criteria applied to patients with cirrhosis or chronic hepatitis B. - Expert pathology diagnosis is confirmed by staining for glypican 3, heat shock protein 70, and glutamine synthetase. 2. **Staging and Treatment of HCC**: - The BCLC staging system remains widely accepted and is used in clinical practice and clinical trials. - Liver transplantation remains the first option for patients with optimal profiles, defined by the BCLC staging system. - Radiofrequency ablation (RFA) is effective for lesions smaller than 2 cm, with a local recurrence rate of less than 1%. - Chemoembolization and sorafenib are recommended for advanced HCC, with sorafenib now considered first-line treatment for patients who cannot undergo more effective therapies. - Sorafenib induces a clinically relevant improvement in time to progression and survival, with manageable associated toxicity. In conclusion, HCC management has evolved from a nearly universal death sentence to a preventable and effectively treatable condition, emphasizing the importance of high-quality screening, proper management of detected lesions, and appropriate therapy based on disease stage.The article provides an update on the management of hepatocellular carcinoma (HCC) based on new information since the 2005 American Association for the Study of Liver Diseases (AASLD) practice guidelines. Key changes include: 1. **Surveillance and Diagnosis**: - New data on HCC risk for hepatitis B, C, and autoimmune hepatitis have been identified. - Surveillance is cost-effective if the expected HCC risk exceeds 1.5% per year for hepatitis C and 0.2% per year for hepatitis B. - Alpha-fetoprotein determination is inadequate for effective surveillance; ultrasound examination is recommended with a screening interval of 6 months. - Diagnosis should be based on imaging techniques and/or biopsy, with dynamic imaging criteria applied to patients with cirrhosis or chronic hepatitis B. - Expert pathology diagnosis is confirmed by staining for glypican 3, heat shock protein 70, and glutamine synthetase. 2. **Staging and Treatment of HCC**: - The BCLC staging system remains widely accepted and is used in clinical practice and clinical trials. - Liver transplantation remains the first option for patients with optimal profiles, defined by the BCLC staging system. - Radiofrequency ablation (RFA) is effective for lesions smaller than 2 cm, with a local recurrence rate of less than 1%. - Chemoembolization and sorafenib are recommended for advanced HCC, with sorafenib now considered first-line treatment for patients who cannot undergo more effective therapies. - Sorafenib induces a clinically relevant improvement in time to progression and survival, with manageable associated toxicity. In conclusion, HCC management has evolved from a nearly universal death sentence to a preventable and effectively treatable condition, emphasizing the importance of high-quality screening, proper management of detected lesions, and appropriate therapy based on disease stage.