Hepatocellular carcinoma (HCC, also called primary liver cancer)) is the most common type of primary liver cancer. It originates in the hepatocytes, which are the main type of liver cells.
70 to 80% 0f all Hepatocellular carcinoma develops in individuals with a predisposition eg liver cirrhosis. HCC represents a new (second) problem developing on background of the existing pre-malignant liver disease.
Symptoms of HCC
Hepatocellular carcinoma symptoms may include abdominal pain, unexplained weight loss, jaundice (yellowing of the skin and eyes), fatigue, loss of appetite, and abdominal swelling.
However, in the early stages, HCC often does not cause noticeable symptoms, making early detection challenging.
Once a tumour nodule develops, it becomes the bigger and primary threat to life and well-being, which has greater impact than the primary liver disease.
Thus, HCC requires immediate treatment. Delaying could result in tumour spread rendering a curable disease incurable.
Because we can identify the people at risk for development of HCC, we can target interventions in this group for maximum impact.
Treatment of HCC
Intervention 1: Decrease risk of development of tumour
- Treatment to reduce liver inflammation and fibrosis eg antiviral therapy for hepatitis B & C.
- Lifestyle changes: avoiding alcohol, maintain a healthy diet and weight.
Intervention 2: Screening
- Keeping a close watch for development of tumour nodules to catch it in early stages of development. This ensures that it can be treated while it is small before it spreads is very effective.
- Continued watch: The predisposition to develop tumour remains in the cirrhotic liver and 50% of patients will develop a second / new tumour with in 3 years, after ablation of screen detected ones.
These patients need to be on continued surveillance for development of new nodules.
How to screen
HCC Screening can be done by a combination of imaging & biomarkers.
Imaging tests
Ultrasound abdomen (US), computed tomography (CT), and magnetic resonance imaging (MRI).
Ultrasound is preferred first modality due to low cost, non-invasive nature and high sensitivity for detecting HCC.
It is performed at 6 monthly intervals or earlier if there are suspicious lesions. CT and MRI are done to conform nature of indeterminate / doubtful lesions.
The American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) recommend ultrasound as the primary screening test and additional imaging and biomarker tests as needed.
Biomarkers in blood
Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP / PIVKA-2) are secreted into blood by HCC and increase accuracy of screening when used in combination with imaging.
Elevated levels of AFP and DCP are useful to diagnose tumour nodules, distinguish premalignant regenerative lesions from tumour, identify aggressive forms of tumour and predict extent of spread of tumour.
Once HCC has developed, there are multiple methods to treat HCC, and this includes surgery (by surgeon), ablation by heating or freezing (by interventional radiologist), chemotherapy (oncologist) and radiation in some stages (radiation oncologist).
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