Hepatocellular Cancer

How common is hepatocellular cancer?

Hepatocellular cancer is the most common type of cancer that originates in the liver and is the most common cause of death in patients with cirrhosis. For unknown reasons it seems to occur more often in men than in women.

Who are more likely to get hepatocellular cancer?

The risk of developing hepatocellular carcinoma in a cirrhotic liver after 20 years is about 5% in women and 20% in men. It is often associated with chronic hepatitis B or C infection and alcohol abuse. Rare diseases, such as haemochromatosis and α-1 antitrypsin deficiency, increase the risk of hepatocellular carcinoma.

Are there any symptoms indicative of hepatocellular carcinoma?

In patients with cirrhosis, the development of hepatocellular carcinoma often leads to a rapid deterioration of already impaired liver function which can delay diagnosis as it can be mistaken for progression of cirrhosis. Symptoms are non-specific as they are mainly due to the underlying cirrhosis and include abdominal pain, jaundice (yellowing of the skin and conjunctivae), ascites (fluid collection in the abdomen), blood coagulation disorders with skin ecchymosis or bleeding manifestations, loss of appetite, weight loss, nausea and vomiting. In patients without cirrhosis it may occur only with abdominal pain and a palpable mass in the liver area. Symptoms such as diffuse pain from metastatic bone disease may also occur.

What tests does a patient with suspected hepatocellular cancer undergo?

Liver function testing with blood tests is usually pathological, but this alone is not a criterion for diagnosing hepatocellular carcinoma. The measurement of the alpha-fetoprotein (a-FP) marker  helps in the diagnosis of the disease. In patients with cirrhosis, levels <10 ng/ml remove the diagnosis, whereas values >500 ng/ml almost confirm the disease. Liver ultrasound or CT scan usually reveal the presence of a large mass or multiple smaller ones, but when liver cirrhosis coexists, the presence of cirrhotic nodules can make the differential diagnosis between cirrhosis and cancer difficult.

How is hepatocellular cancer diagnosed?

Biopsy of the lesion confirms the diagnosis but it may not be possible to perform due to impairment of liver function and coagulation disorders.

What are the treatments available today?

Depending on the extent of the disease, local or systemic treatments are followed: surgical cancellation, less invasive techniques such as radio wave or radiofrequency thermocautery, intra-arterial embolization, chemoembolization and cryopreservation, treatments with specific drugs that prevent the proliferation of cancer cells and promote their apoptosis, and finally chemotherapy.