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A total of 130 million people are presumed to be infected with the hepatits C virus but the infection mostly runs a slow course and only causes problems when people age, have immune impairments or significant cofactors such as excess alcohol consumption or obesity. Age has been determined as a major risk factor for advanced fibrosis and cirrhosis, while treatment, which is needed most for those with cirrhosis, is more difficult once advanced fibrosis is present. The current treatment is thought to be less effective in older people, although few data are available to reliably prove this. As some people with cirrhosis and advanced liver disease can still achieve viral clearance, these patients should be referred to a hepatologist for work-up and treatment decision.

The diagnosis and treatment of hepatocellular carcinoma (HCC) have witnessed major changes over the past decade. Until the early 1990s, HCC was a relatively rare malignancy, typically diagnosed at an advanced stage in a symptomatic patient, and there were no known effective palliative or therapeutic options. However, the rising incidence of HCC in several regions around the world coupled with emerging evidence for efficacy of screening in high-risk patients, liver transplantation as a curative option in select patients, ability to make definitive diagnosis using high-resolution imaging of the liver, less dependency on obtaining tissue diagnosis, and proven efficacy of transarterial chemoembolization and sorafenib as palliative therapy have improved the outlook for HCC patients. In this article, we present a summary of the most recent information on screening, diagnosis, staging, and different treatment modalities of HCC, as well as our recommended management approach.