• Clinical science

Hepatocellular carcinoma

Summary

Hepatocellular carcinoma (HCC) is a malignant, most often solitary tumor of the liver, which occurs primarily in patients with preexisting liver cirrhosis or chronic hepatitis. Typically, it is an incidental diagnosis in these high-risk patients that is made either via ultrasound or an increase in the hepatic tumor marker alpha-fetoprotein. Most patients typically present with symptoms caused by underlying disease (e.g., ascites, jaundice) rather than the tumor itself. Potentially curative treatment options include tumor resection, liver transplantation, and ablative therapies. Unfortunately, it is usually not possible to remove all tumor tissue, which explains the poor prognosis of HCC. In western countries, the five-year survival is less than 50%.

Epidemiology

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Aflatoxins are considered one of the most potent carcinogens!

Clinical features

Diagnostics

Laboratory tests

In patients with cirrhosis of the liver or chronic hepatitis B/C infection, AFP is used as a screening test for HCC!

Imaging

Liver biopsy

  • Can provide a definitive diagnosis but carries the risk of bleeding and tumor spread
  • Recommended when both lab and imaging studies are inconclusive

Differential diagnoses

Malignant liver tumors

Benign liver tumors

The differential diagnoses listed here are not exhaustive.

Treatment

  • Curative therapeutic options: potentially for patients with retained liver function [6]
    • Surgical resection
    • Liver transplantation
    • Ablative therapies (mostly palliative, but can also be curative) result in shrinking and scarring of the tumor
  • Follow-up
  • Palliative care: primarily for decompensated disease, unresectable, multinodular disease, or metastatic disease

Complications

We list the most important complications. The selection is not exhaustive.

Prognosis

  • 5-year survival rate
    • Western countries: 27–49%
    • Asia and Africa: < 10%
last updated 09/08/2020
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