Hepatocellular Carcinoma (HCC) is a major healthcare problem. Almost ninety percent of
HCCs develops on cirrhosis due to chronic viral hepatitis, Non-Alcoholic Steatohepatitis (NASH) and
alcohol abuse. Alcohol itself is defined a strong human carcinogenic agent. Some genetic polymorphisms
in alcohol-metabolizing systems and more recently, some sequence variations within the genes
coding for patatin-like phospholipase encoding 3 (PNPLA3) and Transmembrane 6 superfamily 2
(TM6SF2), have been found to promote liver fibrosis in alcohol abuse, until HCC development. The
current management of HCC is related to tumor burden and liver function and it does not differ in alcoholics,
although in alcoholics the surveillance for HCC could be less effective because socioeconomic
context, such as the recall policy, the stage at the diagnosis and the prognosis are not different compared to viral
HCCs. On regards of loco-regional treatment options, there have not been significant advances in the last few years,
though an increasing role will be probably reserved to radio embolization and irreversible electroporation in the next future.
Sorafenib (SOR) is still the only drug approved as systemic therapy in patients with HCC, whereas immunotherapy
represents a promising approach for the treatment of HCC.