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The resultant hypoxia leads to the activation of cellular stress response pathways induced by the hypoxia induced factor 1 (HIF-1) transcription factor

The success of newer options such as chemoembolization, metronomic therapy, antiangiogenic drugs, and tyrosine kinase inhibitors in the treatment of these patients has not been clearly established.41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 Hepatocellular Carcinomas The macroscopic presentation is clinically very important (see Figure 61-26 ), as 100% of the diffuse forms have metastasis at the time of diagnosis, versus 37% of the isolated (massive or nodular) clinical presentations