The diagnosis, treatment, and prognosis of this liver cancer can be burdensome for patients.
Hepatocellular carcinoma is uncommon among all types of cancer but is the most common of all primary liver cancers. The disease has many causes and often carries a poor expected outcome. As with many conditions, knowledge of hepatocellular carcinoma can aid in prevention and coping throughout the disease course.
Causes
Cirrhosis of the liver is the most common cause of hepatocellular carcinoma, with 80% of hepatocellular carcinoma patients having concurrent liver cirrhosis. In turn, the major causes of cirrhosis include alcohol, hepatitis B, and hepatitis C. Hepatocellular carcinoma may also result from hemochromatosis, the carcinogen aflatoxin, primary biliary cirrhosis, alpha-1 antitrypsin deficiency, and oral contraceptives.
Symptoms and Signs
Often, the clinical manifestations directly stemming from hepatocellular carcinoma do not show up until the later stages of the disease. The patient may report symptoms like upper abdominal pain and unexplained weight loss. Otherwise, many symptoms and signs are the result of liver cirrhosis itself, including but not limited to accumulation of fluid in the abdominal cavity (ascites) and altered mental status due to nitrogenous wastes (hepatic encephalopathy).
Diagnosis
The diagnosis of hepatocellular carcinoma requires blood testing, imaging studies, and histological confirmation. One test is the serum level of alpha-fetoprotein (AFP), which is generally elevated in the presence of hepatocellular carcinoma. This is accompanied by ultrasound imaging of the liver, which is usually cheap and reliable. Nevertheless, some cases require imaging by computed tomography (CT) and/or magnetic resonance imaging (MRI) if the results of ultrasound are ambiguous. Finally, a biopsy of the liver with microscopic analysis by a pathologist can confirm or rule out hepatocellular carcinoma once and for all.
Staging
As with any cancer, staging to note how far the tumor has advanced is important. For hepatocellular carcinoma, there are two staging systems used. The tumor, node, and metastasis (TNM) scoring system stages the tumor based on tumor size (T), advancement to nearby lymph nodes (N), and metastasis to the rest of the body (M). Another system is the Cancer of the Liver Italian Program (CLIP) scoring system that takes into account the tumor morphology, the patient's AFP level, and other factors. Generally, the TNM system is used for patients whose hepatocellular carcinoma can be removed surgically and the CLIP system is used for all other patients.
Treatment
If the amount of tumor is not extensive and the remainder of the liver is still functional, surgical resection with partial hepatectomy is considered. In other cases, doctors may consider destruction of the tumor with a catheter directly into the tumor (ablation) or with toxic agents through the liver bloodstream (chemoembolization). Liver transplantation remains a last resort option, particularly for those with significantly limited function of the liver.
Chemotherapy, a treatment for many cancers, can be attempted for hepatocellular carcinoma but this cancer is known to be relatively resistant to this treatment. Radiation therapy is not considered effective for hepatocellular carcinoma.
Prognosis
Life expectancy ranges from a few months for a patient with hepatocellular carcinoma who is too ill to be treated to a few years for a patient who undergoes partial hepatectomy. The outcome can also be improved with preventive measures, such as hepatitis B vaccines and management of alcoholism.
