TERT and Cirrhosis: The multistep nature of human hepatocarcinogenesis has long been suggested, and convincingly demonstrated by a recent molecular study showing a progressive increase in the rate of mutations of the telomerase reverse transcriptase (TERT) gene promoter from cirrhosis (no mutation) to LGDN (6%), HGDN (19%), eHCC (61%), small pHCC (42%) to advanced HCC (64%) [4].