A review on liver cancer: Challenges, molecular insights and future directions in management

Liver cancer, predominantly hepatocellular carcinoma (HCC), poses a major global health challenge due to late diagnosis, poor prognosis and limited therapeutic success. Despite advances in molecular and immunological research, the complex pathogenesis and tumor microenvironment hinder effective management. This review summarizes current insights into etiology, molecular mechanisms, diagnostic limitations and therapeutic strategies, emphasizing genetic, epigenetic, viral, metabolic and environmental factors driving hepatocarcinogenesis. Recent multi-omics and liquid biopsy technologies enable early detection, biomarker discovery and personalized therapy. Precision oncology, incorporating immunotherapy, targeted agents and combination regimens, has improved outcomes, though resistance and recurrence remain challenges. Liver transplantation offers curative potential but faces donor scarcity and post-transplant complications. Emerging innovations such as molecular profiling, neoadjuvant immunotherapy and advanced drug delivery systems promise enhanced efficacy. Integrating spatial multi-omics, single-cell transcriptomics and Artificial Intelligence will refine diagnosis, prognosis and therapy, transforming liver cancer into a more manageable disease.