Medical approach to treatments of small liver cancer        FAN Jia, SHI Ying-hong, GAO Qiang. Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author：FAN Jia, E-mail: jiafan99@yahoo.com
Abstract    Currently, surgical resection remains the prior treatment choice for small hepatocellular carcinoma (HCC), and long term survival is predictable in those received hepatectomy. The advent and technical progression in radiofrequency and microwave ablation provide alternative choices for small HCC. Although local ablative therapies have yield similar overall survival rates to that of surgical resection, surgical resection is superior to local ablative therapies in terms of recurrence rate and tumor-free survival. Liver transplantation simultaneously removes HCC and the underlying diseased liver, and thus eliminates the possibility of multicentric tumor occurrences. Consequently, liver transplantation for small HCC has a slightly higher survival rate and a relatively low recurrence rate, as compared with surgical resection. Nonetheless, the high post-treatment recurrence/metastasis rate of small HCC remains unchanged, in which the characteristics of HCC cells, tumor microenvironment and the underlying hepatitis collectively contribute. In future clinical practice, we must bear in mind that only early diagnosis, evidence based treatment modalities and translation from bench to bedside were properly administrated, could additional breakthroughs in small HCC can be achieved.