Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is one of and is the most common types of liver cancer. Other types of liver cancer – intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common. HCC is considered to be one of the leading causes of cancer-related death worldwide. It is associated with liver cirrhosis in western populations, but can occur in non-cirrhotuics especially in eastern populations with hepatitis B virus (HBV) infection.

POSSIBLE SYMPTOMS

Most people don’t exhibit symptoms in the early stages of HCC. However, when signs and symptoms do appear, they might be related to cancer or to chronic liver disease.

RISK FACTORS

The risk of hepatocellular carcinoma is higher in people with cirrhosis caused by infection with HBV, HCV, alcohol abuse or accumulation of fat in the liver (NAFLD/NASH). Chronic liver disease due to HBV or HCV or alcohol accounts for the majority of HCC cases, whilst the incidence of nonalcoholic fatty liver disease has been rising and it is also associated with the development of HCC. [1]

DIAGNOSIS

Hepatocellular carcinoma (HCC) is usually diagnosed through screening program to detect early HCC using ultrasounds every 6 months in people with cirrhosis. Once a lesion has been identified, the diagnosis of HCC is made on the presence of characteristic features of an HCC using dynamic imaging tests such as CT and MRI with contrast that should confirm the diagnosis in a patient deemed to be at risk of the disease.

PROGNOSTIC MODELS AND HCC STRATIFICATION

Barcelona Clinic Liver Cancer (BCLC) is the most used prognostic model of HCC. This classification categorize prognosis of HCC in 5 groups and guide the management of hepatocellular carcinoma.

Abbreviations: PST: performance status (0-2), Child-Pugh, A, B, C. classification cirrhosis score, N: extrahepatic lymphatic nodules, M: extrahepatic metastasis.

CURRENT TREATMENT MODALITIES

Treatments of hepatocellular carcinoma include, in early stages 0 or A:

  • Resection (removing the cancer and a part of healthy tissue that surrounds it)
  • Liver transplant surgery (remove the entire liver and replace it with a liver from a donor, cadaveric or living donor)
  • Destroying cancer cells with heat or cold (ablation)

If the HCC is classified as intermediate stage, treatment is named loco-regional and include:

  • Delivering chemotherapy or radiation directly to cancer cells (TACE, Transarterial chemo-embolization or similar)

In more advanced HCC treatment will be systemic such as:

  • Targeted drug therapy. Targeted drugs, such as sorafenib, regorafenib, nivolumab etc. may help slow the progression of the disease in people with advanced liver cancer.

In more advanced HCC treatment will be systemic such as:

Due to the HCC characteristics, patient has two diseases cirrhosis and cancer and the treatment usually will be escalating through the stages, patients care would be on a multidisciplinary team based to improve management and assess and optimize risks.

If you are, or a person or you know someone that is suffering from the symptoms described above and might be considered to be affected by the risk factors that might lead to the development of HCC, contact your doctor or a liver patient organization in your country. European Liver Patients’ Association is an umbrella organization with the national patient organizations as members. List of our members can be found here.

[1] Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis, Yezaz Ahmed Ghouri, Idrees Mian, and Julie H. Rowe, MD, Journal of Carcinogenesis 2017; 16: 1.