• Clinical science

Hepatocellular carcinoma


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%.



Epidemiological data refers to the US, unless otherwise specified.


Aflatoxins are considered one of the most potent carcinogens!


Clinical features



Laboratory tests

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


  • Ultrasound: best initial test
    • Irregular mass borders
    • Echogenicity ranging from homogeneous to inhomogeneous and from hypoechoic to hyperechoic
    • Vascular invasion of the tumor may be visible (e.g., portal vein thrombosis)
    • Underlying cirrhosis may be seen
  • Abdominal CT or MRI (with contrast): confirmatory test
    • Hypodense lesions (single or multifocal)
    • Irregular mass borders
    • Possible local invasion

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.




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