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Hepatocellular Carcinoma (HCC)

Hepatocellular Carcinoma (HCC)



Overview

What is hepatocellular carcinoma (HCC)?

Hepatocellular carcinoma is the most common form of liver cancer. It’s an aggressive (fast-growing) cancer most common in people with advanced liver disease, like cirrhosis of the liver. Increasingly, people diagnosed with HCC have a liver condition that sometimes leads to cirrhosis called metabolic dysfunction-associated steatotic liver disease (MASLD).

In the beginning, hepatocellular carcinoma grows slowly. Surgery to remove the tumor or a liver transplant can treat HCC in its early stages. But most people don’t learn they have it until it’s advanced and spreading more quickly. Eventually, it can lead to liver failure. At this point, HCC is challenging for providers to treat.

Given how serious it is, you should receive regular checks for signs of HCC if you have cirrhosis or MASLD.

Symptoms

Tumors may not cause symptoms in the early stages. But as HCC progresses, you may notice:

Fullness or a knot under your ribs on your right side (symptoms of an enlarged liver).

Fullness under your ribs on your left side (symptoms of an enlarged spleen).

Eyes and skin turning yellow (signs of jaundice).

A stomach that feels swollen, like it’s filling up with fluid.

Loss of appetite or feeling full after a small meal.

Unexplained weight loss.

Nausea and vomiting.

Itching.

Many conditions cause similar symptoms, and most aren’t as serious as hepatocellular cancer. So, try not to panic if you experience one or more of them. But if symptoms last longer than two weeks, it’s best to see a healthcare provider.

Causes

Most people diagnosed with HCC have cirrhosis of the liver (approximately 80%) although some have a a condition that can lead to cirrhosis of the liver. In some instances, the condition never progresses to cirrhosis, but people still develop HCC.

With these conditions, unmanaged long-term liver inflammation can lead to severe scarring and, eventually, HCC.

Risk factors for HCC

Conditions that increase your risk of HCC include:

Hepatitis B infection: A viral infection that spreads through bodily fluids. (Hepatitis B infection can lead to HCC even without liver cirrhosis or before cirrhosis occurs.)

Hepatitis C infection: A viral infection that spreads through blood.

Metabolic dysfunction-associated steatotic liver disease (MASLD): A condition that causes excess fat to build up in your liver. You’re more likely to have MASLD if you have obesity, an inherited metabolic syndrome or Type 2 diabetes.

Alcohol use disorder: Alcohol is difficult for your liver to process. Drinking too much of it can eventually lead to cirrhosis and liver cancer.

If you belong to a high-risk group, your healthcare provider may suggest regular screenings to catch HCC early, when it’s treatable. They can also help you take steps to reduce risk factors, like helping you quit smoking or drinking. They can help you manage chronic conditions that put you at risk, like hepatitis infections and diabetes.

Diagnosis

Your healthcare provider will do a physical exam. They’ll also ask about your medical history, symptoms and lifestyle.

Tests to help confirm a diagnosis include:

Blood tests: Your provider may check your blood for signs of HCC, like high alpha-fetoprotein (AFP) levels. Elevated AFP may signal HCC or a condition that can lead to HCC, like a hepatitis infection or cirrhosis of the liver.

Imaging scans: Imaging procedures, like an ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) or angiography can show tumors (or signs of a tumor) inside your liver.

Liver biopsy: Your provider may biopsy a liver tumor to test the tissue for cancer cells. You may need this test if your bloodwork results and imaging scans aren’t definitive enough for a diagnosis.

HCC is an unusual cancer because in people with cirrhosis, providers can make the diagnosis based on the tumor(s) having certain features on an MRI or CT scan without needing to do a biopsy.

How is HCC staged?

Cancer staging for HCC allows your healthcare provider to determine how advanced it is. It also helps them plan treatments and determine your prognosis (outlook). To stage HCC, providers consider:

How big the tumor is.

How much it’s grown into nearby tissue (including your lymph nodes).

Whether it’s spread beyond your liver (metastatic cancer).

How advanced the underlying liver disease is.

Treatment

How is hepatocellular carcinoma treated?

Treatments include:

Surgery: The surgical treatments for HCC are hepatectomy (removing the diseased part of your liver) or a liver transplant. You may receive a hepatectomy if the tumor is only limited to one part of your liver. If your liver isn’t healthy enough for a hepatectomy, a liver transplant may be an option.

Ablation therapy: Providers performing ablation use a special needle to burn tumors. The needle may direct energy that’s extremely hot (microwaves or radiofrequency waves) or freezing cold.

Embolization: Embolization implants a substance directly into the arteries supplying the tumor, stopping blood flow. Chemoembolization implants a substance that contains chemotherapy drugs. Radioembolization implants small beads of radiation.

Radiation therapy: Providers may recommend radiation therapy to treat small tumors that they can’t remove with surgery or destroy using ablation. Stereotactic body radiation therapy (SBRT) is a specific type of radiation treatment that providers use to treat HCC.

Immunotherapy: Immunotherapy medicines also treat advanced HCC. They help your immune system identify and fight cancer cells.

Targeted therapy: Targeted therapy medicines treat advanced HCC. This treatment switches off the signal that tells cancer cells to keep growing.

Your healthcare provider may suggest participating in a clinical trial to try new HCC treatments. They may also recommend palliative care to help you manage cancer symptoms and treatment side effects. Palliative care can improve your experience whether you’re living with long-term disease or receiving treatment for early-stage, curable HCC.

Type of Doctor Department : Hepatologists , Oncologists

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