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Hepatocellular Carcinoma

Last updated May 29, 2018

Approved by: Maulik P. Purohit MD MPH

Hepatocellular Carcinoma (HCC) is a malignant tumor that develops in the liver, due to uncontrolled liver cell proliferation. It is a common tumor that occurs worldwide.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Liver Tumor (Hepatocellular Carcinoma)
  • Malignant Hepatoma (Hepatocellular Carcinoma)
  • Primary Liver Cell Carcinoma (Hepatocellular Carcinoma)

What is Hepatocellular Carcinoma? (Definition/Background Information)

  • Hepatocellular Carcinoma (HCC) is a malignant tumor that develops in the liver, due to uncontrolled liver cell proliferation. It is a common tumor that occurs worldwide
  • In many individuals, Hepatocellular Carcinoma develops, when the liver has undergone severe trauma or damage for various reasons
  • The common signs and symptoms of this liver condition include abdominal pain, nausea, vomiting, yellowing of the skin and eyes, and frequent bruising or bleeding
  • A diagnosis of HCC is usually made through a liver biopsy that is performed, either by an open biopsy, or a core biopsy using radiological guidance
  • The treatment for HCC is through a combination of modes, which includes surgical removal of the tumor, chemotherapy, and radiation therapy. In some instances a liver transplantation may be considered as a treatment option
  • The prognosis of Hepatocellular Carcinoma depends on the stage of the tumor. The lower the stage, better is the prognosis

Who gets Hepatocellular Carcinoma? (Age and Sex Distribution)

  • Hepatocellular Carcinoma occurs worldwide. This liver cancer usually affects individuals in their 50s and 60s
  • It is important to note that individuals of any age are prone to HCC
  • The condition is 3-times more common in males, than females
  • There is no known ethnic or racial preference; however, the incidence of HCC is higher among Asians and Pacific Islanders

What are the Risk Factors for Hepatocellular Carcinoma? (Predisposing Factors)

Following are the risk factors of Hepatocellular Carcinoma:

  • Gender: Men are 3-times more likelier to develop HCC, than women
  • Family history: Having a family member with Hepatocellular Carcinoma increases one’s chances of the condition, during one’s lifetime. This is due to the mutations that can cause HCC, being passed down from one generation to another
  • Viral infections: Viral infections, such as hepatitis B or hepatitis C, increase the risk of HCC. These infections cause certain genetic mutation in the liver cells, which in turn can cause uncontrolled proliferations, resulting in a malignancy
  • Excessive alcohol consumption: Excessive alcohol consumption damages the liver cells. As the liver cells repair themselves, from the alcohol-induced damage, genetic mutations may occur, resulting in the development of such liver cancers
  • Exposure to aflatoxins: Aflatoxin is a toxin that comes from a species of fungus - aspergillus. This toxin is present in uncooked, rotten peanuts. Eating raw, contaminated peanuts with aspergillus fungus can result in an increased risk of HCC
  • Excess body iron: An increased iron in the body, especially in the liver, can cause Hepatocellular Carcinoma. Hence, individuals with hemochromatosis, a condition which causes abnormal iron deposition within the liver, have a high risk for the development of HCC
  • Cirrhosis: The development of scarring in the liver, termed cirrhosis, due to a variety of causes can result in the formation of HCC

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hepatocellular Carcinoma? (Etiology)

  • The liver is an organ that is able to regenerate itself, when damaged. During the regeneration process, if genetic mutations occur, then uncontrolled growth of liver cells may result in Hepatocellular Carcinoma
  • HCC typically arises in situations that result in chronic liver injuries. Such chronic liver injuries may occur due to:
    • Drug toxicities to liver
    • Aflatoxin toxicity to liver
    • Infections, such as hepatitis B and hepatitis C
    • Abnormal iron deposition within the liver tissue
  • Increased alcohol consumption causes liver damage, which in turn can increase one’s chances of this type of liver cancer
  • Hepatocellular Carcinoma is termed so, because the cell of origin of this cancer is a hepatocyte (the chief functional liver cell)

What are the Signs and Symptoms of Hepatocellular Carcinoma?

The common signs and symptoms of Hepatocellular Carcinoma may include:

  • Abdominal pain, which can be either due to tumor growth, or due to metastasis of the cancer within the abdomen
  • Weight loss
  • Jaundice; yellowing of skin and eyes, due to accumulation of bilirubin caused by liver failure
  • Enlarged abdomen due to accumulation of fluid within the peritoneal sac, called ascites
  • Nausea and vomiting
  • Easy bruising or bleeding that occurs as a result of liver failure. The liver is responsible for making clotting factors that help with coagulation of blood. When HCC causes liver failure, the body would have less amount of clotting factors, resulting in easy bruising or bleeding

In many instances, Hepatocellular Carcinoma is often silent during the initial stages, without any signs and symptoms. Also, not all HCC affected individuals may notice the symptoms.

How is Hepatocellular Carcinoma Diagnosed?

A diagnosis of Hepatocellular Carcinoma is made using the following tools:

  • Physical examination with evaluation of the patient’s medical history. The medical history would include the evaluation of one’s family history of liver cancer, alcohol use, history of hepatitis viral infections, and exposure to various toxins
  • Various blood tests, including complete blood count (CBC) and liver function tests
  • Radiological studies: Ultrasound of the abdomen and CT or MRI scan of the abdomen
  • Liver biopsy: The biopsy of liver of the abnormal tissue is examined under a microscope by a pathologist, to arrive at a definitive diagnosis. Occasionally, the pathologist may perform additional tests on the tissue to arrive at a definitive diagnosis. The biopsy of liver can be performed using any of the following methods:
    • Fine needle aspiration (FNA) technique
    • Core needle biopsy of liver
    • Open biopsy using wedge liver resections

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hepatocellular Carcinoma?

Following are the possible complications of Hepatocellular Carcinoma:

  • HCC may spread to other parts of the body, due to metastasis
  • It can affect the functioning of liver, resulting in liver failure
  • Complications may arise during chemotherapy and radiation therapy, due to the toxic medication or radiation effect

How is Hepatocellular Carcinoma Treated?

Treatment measures for Hepatocellular Carcinoma may include the following:

  • The treatment of HCC depends on the stage of the tumor. During the early stages, when the tumor is confined to the liver, an excision of the tumor generally results in a cure
  • With higher stage tumors, when it has metastasized to other regions or different body parts, chemotherapy and/or radiation therapy in addition to surgery, may be considered
  • In some situations, a liver transplantation may be a treatment option. The healthcare provider shall arrive at a treatment plan, based on the individual’s specific circumstance/condition
  • Post-operative care is important: A minimum activity level is to be ensured, until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important

How can Hepatocellular Carcinoma be Prevented?

In a majority of cases, there is no method to prevent Hepatocellular Carcinoma. However, following are a few steps to reduce the risk for the condition:

  • In individuals, who are at risk for developing hepatitis B or hepatitis C, vaccination may be given to prevent the viral infection
  • In individuals, who have been diagnosed with hemochromatosis, appropriate therapy should be taken to reduce the iron overload in liver, to help prevent HCC
  • Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory for those who have already endured the tumor. This is due to its high metastasizing potential. Often several years of active vigilance is necessary

What is the Prognosis of Hepatocellular Carcinoma? (Outcomes/Resolutions)

The prognosis of Hepatocellular Carcinoma depends on the stage of the tumor.

  • With lower-stage tumors, when the tumor is confined to the liver, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • In patients with higher-stage metastatic HCC, the median survival rate is about 3-6months
  • Hepatitis C infection is a viral infection that causes inflammation and injury to the liver. It is caused by hepatitis C virus (HCV), which is transmitted through physical contact

Additional and Relevant Useful Information for Hepatocellular Carcinoma:

The following article link will help you understand hepatitis C viral infection:

http://www.dovemed.com/diseases-conditions/hepatitis-c-infection/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 23, 2014
Last updated: May 29, 2018