Hepatocellular carcinoma: Review of disease and tumor biomarkers

Abstract

Hepatocellular carcinoma (HCC) is a common malignancy and now the second commonest global cause of cancer death. HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation. As the option for curative treatments is limited to early stage cancers, diagnosis in non-symptomatic individuals is crucial. International guidelines advise regular surveillance of high-risk populations but the current tools lack sufficient sensitivity for early stage tumors on the background of a cirrhotic nodular liver. A number of novel biomarkers have now been suggested in the literature, which may reinforce the current surveillance methods. In addition, recent metabonomic and proteomic discoveries have established specific metabolite expressions in HCC, according to Warburg’s phenomenon of altered energy metabolism. With clinical validation, a simple and non-invasive test from the serum or urine may be performed to diagnose HCC, particularly benefiting low resource regions where the burden of HCC is highest.

Keywords: Hepatocellular carcinoma; Biomarker; Metabonomics; Warburg hypothesis; Serum; Plasma; Urine

Core tip: Many independent authors have utilized quantitative techniques, such as ¹H nuclear magnetic resonance and mass spectrometry to discover novel biomarkers to aid early diagnosis, following the removal of alpha fetoprotein from international surveillance guidelines. However, relatively little effort has been directed to translate these findings to the clinical setting. hepatocellular carcinoma (HCC) is a global issue and the vast majority of the burden is placed upon resource-limited regions, where presentations are late and management techniques for advanced tumors are unavailable. Early identification through a simple serum or urinary investigation, therefore, may be a pivotal step in addressing the global burden of HCC.