Chapter 5 **The Diagnostic and Prognostic Potential of MicroRNAs for Hepatocellular Carcinoma 103**

Xi-Dai Long, Wei-Zhong Tang, Jun Lu, Xiao-Ying Huang, Jin-Guang Yao, Tian-Qi Zhang, Xing-Zhizi Wang, Qun-Ying Su, Chun-Ying Luo, Xue-Ming Wu, Chao Wang, Li-Xia Zeng, Qiang Xia and Yun Ma

Preface

top positions as HCC candidates.

The field of cancer research is one of the most dynamic ones in today's medical world. From screening and early diagnosis to deciphering novel molecular pathways and innovative sur‐ gical solutions, the ongoing battle against malignancies seems to progress to new grounds. Since this "silent killer" became acknowledged as one of the leading causes of death world‐ wide, the landscape continuously changes. The incidence of some tumors has been on the rise, while mortality decreased in other cases. All this is due to new risk factors attributed to modern society on one hand, and more diagnostic capabilities leading to early detection

In this ever-changing context, hepatocellular carcinoma (HCC) is a very interesting culprit. One of the few malignancies with an almost omnipresent association with previous patholo‐ gy of the same organ, HCC was long thought to provide little surprises. However, since di‐ etary habits and heavy industrialization led to new types of liver injury, what was once thought of as the only certain "at risk" population is now far more diverse. Endemic areas slowly but surely shift, along with modern efficient treatment options for viral hepatitis and the rise of obesity and metabolic disorders – that quietly place other population groups in

Current guidelines suffered incremental changes over the last years, as imaging took the leading role in diagnosis, with the advent of contrast agents that can accurately characterize liver lesions. Recent acknowledgment of non-invasive, minimum risk investigations such as contrast-enhanced ultrasound already means better diagnostic options in a variety of novel settings, and for even more categories of patients compared to just a few years ago. As mod‐ ern imaging methods become more available at decreased costs – thus being available in even smaller medical centers, the expertise of clinicians on all continents gradually increases, lead‐ ing to more cases of early HCC diagnosed (and, thus, candidates for curative surgery).

Oncological treatment for HCC has been the subject of long academic debates in recent years. With limited options available, due to a small number of targetable cellular and mo‐ lecular pathways, it seemed a lost battle; however, recent research proves the contrary. In recent years we have witnessed surprising breakthroughs, new lines of therapy, perhaps even a shift in paradigm in regards to invasive loco-regional treatment options. More effi‐ cient targeted drug-delivery methods, coupled with minimally invasive trans-arterial cathe‐ ter-based solutions, may offer a broader array of options for intermediate stages and otherwise untreatable HCCs. Surgery has become more refined, more nuanced in its thera‐ peutic options and goals. Novel techniques, based on minimally invasive set-ups, offer in‐

creased survivability at a lower time and anatomic cost for the patient.

coupled with more effective therapeutic options, on the other hand.

#### **Section 3 Treatment Modalities for Hepatocellular Carcinoma 129**

Chapter 6 **Oncogenic Secretory Clusterin: A Promising Therapeutic Target for Hepatocellular Carcinoma 131** Min Yao, Wenjie Zheng, Li Wang, Miao Fang, Dengfu Yao and Zhizheng Dong

Chapter 7 **Minimally Invasive Therapies for Hepatocellular Carcinoma: Mechanisms of Local Control and Systemic Immunologic Response 149** Andrew W. Ritchey, Joshua D. Kuban and Rahul A. Sheth

Chapter 8 **Emerging Targeted Therapies for Treatment of Hepatocellular Carcinoma (HCC) 173**

Sarwat Fatima, Nikki Pui-Yue Lee, Hiu Yee Kwan and Zhao Xiang Bian
