Hepatocellular carcinoma (HCC) makes up around 90% of primary liver cancers. As of 2018, it was the fifth most common cancer in terms of new cases and the third in terms of mortality. It is predicted that the number of new cases will rise from approximately 800,000 in 2018 to 1.3 million in 2040.
Chronic viral hepatitis B and C, alcoholic liver disease (including steatosis, steatohepatitis, and alcoholic cirrhosis), non-alcoholic steatohepatitis (linked to diabetes, metabolic syndrome, and obesity), and cirrhosis increase the risk of developing HCC. People at higher risk of developing HCC should undergo abdominal ultrasound examinations every six months.
Early-stage HCC typically does not cause specific symptoms. Possible symptoms of hepatocellular carcinoma include weight loss, general weakness, upper abdominal pain, abdominal swelling, jaundice, light-colored stools, and dark urine.
Tests and procedures used to diagnose HCC include laboratory analysis (including a hepatogram and AFP tumour marker), abdominal ultrasound examination, and CT and MR scans of the abdomen. Sometimes, a sample of liver tissue must be taken for pathohistological analysis to achieve a definitive diagnosis. This invasive diagnostic procedure is the most reliable way to diagnose HCC.
HCC treatment depends on the stage of the disease, which is determined using the Barcelona classification system based on three factors: the patient’s general status (performance status), liver function (using the Child-Pugh score and ICG test), and the number, location, and size of the tumour. Surgery (liver resection and transplantation) is the primary treatment option for HCC, with a five-year survival rate of 60 to 80% achievable with a good selection of patients. Multinodular HCC is treated with transarterial chemoembolization (TACE), a radiological procedure where the arterial branch supplying the tumour is occluded with an embolization agent, and a cytostatic is selectively injected into the blood vessel, which reduces its systemic toxic effect. For patients with an advanced stage of the disease (i.e., metastases outside the liver or a malignant tumour thrombus in the portal vein of the liver), systemic biological therapy may be offered. In the terminal phase of the disease, when the patient has impaired liver function or is in poor general health, supportive therapy and general care are administered.
Preventing HCC involves reducing the risk of developing steatohepatitis, liver cirrhosis, and infection with hepatitis B and C viruses. Key prevention measures include a healthy diet, physical activity, moderate consumption of alcoholic beverages, vaccination against hepatitis B, and reducing exposure to hepatitis C.
