الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is a primary cancer of the liver with an established causal link to cirrhosis mostly due to viral hepatitis and alcohol. It is one of the leading causes of cancer death world wide and exhibits marked regional variation in both etiology and mode of presentation. In developing countries HCC often present at late stage with large symptomatic tumor associated with malaise, anorexia, right upper quadrant pain, abdominal bloating, jaundice and liver failure. Patient in developed countries diagnosed in early stages by routine screening of people at risk groups.
The management of HCC is dependent on the size, number and location of the tumor and severity of the underlying liver disease. The choice of therapy is determined by local resources and expertise and so will vary considerably between institutions. Note with regular screening as few as 20% of patient will be suitable for curative treatments such as surgical resection and liver transplantation and therapy of the remainder will be palliative.
Diagnosed HCC is classified (a) resectable (b) nonresectable. Resectable HCC; this depends on liver function, portal hypertension, location, number and size of the tumor. So treatment may be liver resection or liver transplantation.
Liver resection is the first choice in the management of HCC which offers the best chance of survive. However, it is suitable in small portion of cases.
Liver Transplantation is considered in patients with 3 nodules less than 3cm or with single tumors less than 5 cm with liver function impairment. But when long waiting times exist, adjuvant resection or percutaneous treatments are recommended.
There is wide variety of nonsurgical methods of treatment have been used individually or in combination to provide palliation in patients with unresectable HCC. These include percutaneous intralesional injection, cryosurgery, radiofrequency thermal ablation, microwave ablation, laser ablation, transarterial therapy, systemic chemotherapy, hormonal therapy and radiotherapy.
There is recent lines of treatment may carry a hope for patients of HCC,such as gene therapy and target therapy.
No doubt that drug Sorafenib plays an important role in the treatment of the liver cancer (nonresectable liver cancer).
Sorafenib is a small molecule that inhibits tumor-cell proliferation and tumor angiogenesis and increases the rate of apoptosis in a wide range of tumor models .