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Hepatocellular Carcinoma

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Overview

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and usually arises in patients with liver cirrhosis due to any cause. Patients at risk of HCC should be offered screening via 6-monthly ultrasound scans and alpha-fetoprotein measurements. 

Epidemiology

  • HCC is the most common type of primary liver cancer
  • HCC usually develops 20-30 years following the first episode of liver pathology
  • HCC is 4-8 times more common in men
  • The average age of development of HCC is patients in their 60s

Risk Factors

Any cause of cirrhosis can be considered a risk factor:

Presentation

Any deterioration in the signs or symptoms of a patient with chronic liver disease or a known diagnosis of liver cirrhosis should raise suspicion of HCC. HCC often presents late. Features may be:

Differential Diagnoses

Cholangiocarcinoma

  • Courvoisier’s sign may be positive – a palpable mass in the right upper quadrant
  • Raised CA 19-9 levels may be seen

Pancreatic cancer

  • Courvoisier’s sign may be positive – a palpable mass in the right upper quadrant
  • Raised CA 19-9 levels may be seen
  • Imaging may show a ‘double duct’ sign – dilation of the common bile and pancreatic ducts
  • Complications may be present (e.g. steatorrhoea, diabetes mellitus, etc.)

Investigations

Patients at high risk (such as existing liver cirrhosis) of HCC should be offered screening with 6-monthly ultrasound scans and alpha-fetoprotein measurements.

Management

Overview

Management depends on the location and stage of liver cancer. This can involve surgery, liver transplantation, and radiofrequency ablation.

Prognosis

  • The prognosis depends on the severity of the underlying liver disease, as this can affect treatment options
  • Median survival from diagnosis is around 6 months

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