Hepatocellular carcinoma (HCC) is a type of liver cancer. It's a primary liver cancer and is the most common form of cancer that starts in the liver.
HCC differs from cancers that start elsewhere in the body and spread to the liver.
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What Is Hepatocellular Carcinoma?
Hepatocellular carcinomas (HCC) may also be referred to as primary liver cancer, hepatic tumors, or hepatomas.
HCC develops in the liver and affects 20,000 to 25,000 people in the United States each year.
Conditions or diseases associated with HCC include:
- Chronic infection with hepatitis B or hepatitis C.
- Cirrhosis.
- Heavy and long-term use of alcohol.
Approximately 30% of people with HCC show no evidence of an associated condition or disease.
How common is hepatocellular carcinoma?
Hepatocellular carcinoma is the most common form of liver tumor, constituting more than 90% of the primary tumors of the liver. HCC occurs in about 85% of patients with cirrhosis. HCC is now the fifth leading cause of cancer worldwide.
What causes hepatocellular carcinoma?
Doctors don't know for sure what causes HCC. However, the disease is more common in people with other liver conditions.
Environmental factors may play a role in causing HCC, including eating food contaminated with aflatoxin, a fungal poison
Hepatocellular carcinoma risk factors
Some conditions and infections damage the liver over time. This damage may put the liver at risk for developing HCC.
Liver conditions that may put you at greater risk for HCC include:
- Alcoholic liver disease.
- Fatty liver disease.
- Hepatitis B.
- Hepatitis C.
- Metabolic dysfunction-associated steatohepatitis, a type of fatty liver disease.
- Primary biliary cholangitis, an inflammation of the bile ducts.
Complications of hepatocellular carcinoma
HCC complications include:
- Bruising.
- Dark urine.
- Jaundice (a yellow color of the skin and eyes).
- Lack of appetite.
- Light, or clay-colored, stools.
- Swelling or pain in the stomach.
- Unexplained weight loss.
How can I prevent hepatocellular carcinoma?
There's no sure way to prevent HCC.
But you can take actions to lower your risk, such as:
- Getting the hepatitis B vaccine.
- Limiting the amount of alcohol you drink.
- Quitting smoking or avoiding tobacco.
- Treating any liver conditions you may have.
What Are the Signs and Symptoms of Hepatocellular Carcinoma?
Some people with HCC don't have any symptoms, especially when the disease first starts. Sometimes, people notice a lump or feel pain on the right side of their body.
When symptoms start, they may include:
- Abdominal pain.
- Abdominal swelling or mass.
- Fatigue.
- Fluid in the abdomen.
- Unexplained weight loss.
When should I see a doctor about my hepatocellular carcinoma symptoms?
If you are experiencing any of the symptoms associated with HCC, you should see your primary care provider as soon as possible. Conditions that can be associated with HCC, like jaundice, can be a sign of a more serious condition, and you should go to the nearest emergency room if you exhibit symptoms of jaundice.
How Do You Diagnose Hepatocellular Carcinoma?
Doctors diagnose HCC in a few ways.
Along with a physical exam, other diagnostic techniques include:
- Blood tests: To measure levels of alpha-fetoprotein (AFP), a substance in the blood. Higher levels of AFP may be a sign of liver cancer. Doctors also use blood draws to test your liver function.
- Imaging: CT scans, MRI scans, and ultrasounds to look for signs of liver damage or enlargement.
Experts don't always require a liver biopsy to confirm HCC. With a liver biopsy, doctors remove a small piece of liver tissue and study it under a microscope.
After diagnosing HCC, doctors stage the disease. Staging helps them make treatment decisions based on how advanced the cancer is.
In staging HCC, experts look at:
- The location and size of tumors in the liver.
- Whether cancer is only in the liver or has spread to other places in the body.
- Whether cancer has spread to the lymph nodes near the liver.
Doctors also take into account the overall condition of your liver when making treatment plans.
Tests to diagnose hepatocellular carcinoma
Imaging tests
Imaging studies — such as CT scans, MRI scans, or abdominal ultrasounds — can show:
- Any blood clots in the major branches of the portal and hepatic veins.
- Any enlarged lymph nodes.
- Evidence of cirrhosis and its complications.
- The size and location of the tumor(s).
- The vasculature structure surrounding the lesion.
- Whether the cancer has spread beyond the liver.
A bone scan may also be performed to check for the presence of cancer in the bone.
Blood tests
Blood tests will evaluate:
- Platelet count — Which can detect cancer in its early stages. A white cell count below the normal range can be a sign of an enlarged spleen and/or an increase in the blood pressure within the liver’s blood vessels, indicating blockage by a tumor.
- Liver function, specifically:
- Albumin level.
- Blood creatinine level.
- Prothrombin time.
- Transaminase levels (ALT, AST, GGTP).
- Tumor markers — Such as alpha-fetoprotein (AFP).
Blood tests also help doctors determine your general health and how well your liver works, including whether you have been exposed, in the past, to hepatitis B or hepatitis C, and whether the hepatitis is active.
Biopsy
A liver biopsy is the removal of a tissue sample for testing to prove or disprove the existence of HCC.
In addition to a biopsy of the tumor:
- A biopsy will be performed on tissue from the nontumorous part of the liver to help determine the presence or degree of cirrhosis.
- A core-needle biopsy is usually necessary to evaluate the makeup of the tumor.
If the CT scan suggests thrombosis (clotting), you may need a needle-aspiration biopsy of the portal vein. The portal vein drains blood from the gastrointestinal tract and spleen to the liver.
This type of biopsy helps doctors determine whether the tumor is invading the portal vein. Invasion of the portal vein by a tumor has major consequences for the long-term outcome of liver transplantation for HCC.
Hepatocellular carcinoma prognosis
As this form of cancer is common, there are options for treatment, and advances are always being made in treatment. The five-year survival rate from this condition is about 18%.
How Do You Treat Hepatocellular Carcinoma?
Lifestyle changes
Doctors might suggest making certain lifestyle changes to support your liver's overall health, such as:
- Avoiding alcohol.
- Being more active.
- Eating a healthy diet.
- Quitting smoking.
Medical treatments
Medicine and other medical therapies to fight HCC include:
- Chemo — Many drugs are approved for treating HCC, including sorafenib, lenvatinib, atezolimumab, bevacizumab, or other PD-1 checkpoint inhibitors.
- Radiofrequency ablation — Doctors use imaging technology, such as CT scans or ultrasounds, to guide a thin wire into the tumor. Using this wire, doctors apply heat produced by high-frequency electrical currents to destroy cancerous tissue.
- Transarterial chemoembolization — Surgeons insert a thin tube, or catheter, into an artery in the thigh to deliver chemo directly to the tumor. They then shrink the tumor by adding a special drug, or embolization agent, that blocks blood flow to the tumor.
Surgery
Sometimes, surgeons will operate to remove tumors in treating HCC.
In a partial hepatectomy, surgeons remove the tumor and some of the nearby tissue, leaving the liver's healthy tissue intact.
If cancer has advanced, your liver doctor may talk to you about a transplant. In a liver transplant, surgeons take out the entire diseased liver and replace it with a healthy liver from a deceased donor or a lobe of liver from a living donor.
How effective is treatment?
Treatment effectiveness is dependent on the severity of your condition and whether you have any other underlying health issues. If you have an advanced condition and a compromised immune system, you may not be a good candidate for chemotherapy.
Surgery is a more traditional option and may be the best option, as the liver is the only regenerative organ of the body and can recover from surgical removal of segments.
How long does it take to recover after treatment for hepatocellular carcinoma?
Treatments like chemotherapy or radiofrequency ablation can be performed within a day, but may take several sessions to complete treatment. Surgery will require time in the hospital, including up to 12 hours for surgery and time before and after for monitoring your condition and healing progress.
