Hepatocellular carcinoma (HCC) or primary liver cancer originates from the functional cells of the liver called hepatocytes. Hepatocellular carcinoma is responsible for the fourth-highest number of deaths due to cancer globally. Over 80% of HCC cases occur in regions with limited medical and social care resources, particularly in Eastern Asia and sub-Saharan Africa.
Causes associated with the development of HCC
- Infections: Hepatitis B and C
- Fatty liver disease
- Alcohol abuse
- Rare diseases such as Wilson’s disease, alpha-1-antitrypsin deficiency.
- Hepatocellular carcinoma is more common in men than in women.
- Obesity
- Diabetes has been linked to HCC.
- Long-term use of anabolic steroids
Signs and symptoms associated with HCC
- Jaundice (yellowing of eyes and skin)
- Unexplained weight loss accompanied by decreased appetite.
- Abdominal distension and discomfort.
- Nausea
- Pruritus (itching skin)
- Fever
Diagnosis
After a thorough physical and patient history the physician might ask the following:
- Blood testing: Complete liver panel to check for liver function. In addition, alpha-fetoprotein (AFP) is measured. It serves as a marker for tumors as it is produced by liver tumors. Increased levels of AFP may suggest the presence of liver cancer, especially if the AFP level consistently increases over time. For patients with high-risk cirrhosis due to hepatitis C, hepatitis B, or hemochromatosis, their doctor may recommend checking their AFP levels every three to four months.
- Imaging studies: USG, CT, MRI
- Biopsy: While a liver biopsy is the most conclusive method of diagnosis, it may not always be required. If a tumor is visible on an imaging scan and the AFP level is significantly elevated, a diagnosis can be made without the need for a liver biopsy.
Treatment options
The highest chances of long-term survival are for patients with early-stage tumors that can be surgically removed. However, at the time of diagnosis, most liver cancers are inoperable due to advanced cancer or liver disease. Chemotherapy via chemoembolization may be used to shrink tumors and potentially make surgery feasible. Other methods include cryotherapy and radiofrequency ablation. While radiation therapy is limited due to the liver's low tolerance, radiation therapy may be used to ease symptoms or alleviate pain by reducing tumor size, and radioembolization therapy may be used to disrupt blood flow to the tumor.
