Hepatocellular carcinoma

Hepatocellular carcinoma (heh-PA-toh-SEL-yoo-ler KAR-sih-NOH-muh) is a type of adenocarcinoma and the most common type of liver tumor. It includes hepatocellular carcinoma (HCC) and bile duct cancer (cholangiocarcinoma).

Risk factors

Risk factors for HCC include chronic infection with hepatitis B or C and cirrhosis of the liver. Having hepatitis or cirrhosis can increase the risk of developing liver cancer. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for liver cancer include:

Having hepatitis B or hepatitis C; having both hepatitis B and hepatitis C increases the risk even more. Having cirrhosis, which can be caused by:

• hepatitis (especially hepatitis C); or
• drinking large amounts of alcohol for many years or being an alcoholic.
• Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).

Epidemiology

Liver cancer is less common in the United States than in other parts of the world. The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage.

Three of the many important functions of the liver are:

• To filter harmful substances from the blood so they can be passed from the body in stools and urine.
• To make bile to help digest fats from food.
• To store glycogen (sugar), which the body uses for energy.

Anatomy

The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has a right lobe and a left lobe. Each lobe is divided into two sections (not shown).

Types

There are two types of adult primary liver cancer. The two types of adult primary liver cancer are:

• Hepatocellular carcinoma.
• Cholangiocarcinoma (bile duct cancer).

The most common type of adult primary liver cancer is hepatocellular carcinoma. This type of liver cancer is the third leading cause of cancer-related deaths worldwide.

Symptoms

Signs and symptoms of adult primary liver cancer include a lump or pain on the right side. These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:

• A hard lump on the right side just below the rib cage.
• Discomfort in the upper abdomen on the right side.
• A swollen abdomen.
• Pain near the right shoulder blade or in the back.
• Jaundice (yellowing of the skin and whites of the eyes).
• Easy bruising or bleeding.
• Unusual tiredness or weakness.
• Nausea and vomiting.
• Loss of appetite or feelings of fullness after eating a small meal.
• Weight loss for no known reason.
• Pale, chalky bowel movements and dark urine.
• Fever.

Tests

Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer. The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels. Sometimes the AFP level is normal even when there is liver cancer.
• Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase CT. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the liver. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography). Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase MRI.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the sample of cells or tissues include the following:
• Fine-needle aspiration biopsy: The removal of cells, tissue or fluid using a thin needle.
• Core needle biopsy: The removal of cells or tissue using a slightly wider needle.
• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Another instrument is inserted through the same or another incision to remove the tissue samples.

Staging

Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
• How well the liver is working.
• The patient’s general health, including whether there is cirrhosis of the liver.

Stages of Adult Primary Liver Cancer

• After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer.
• The following groups are used to plan treatment.
• BCLC stages 0, A, and B
• BCLC stages C and D

Treatment

There are different types of treatment for patients with adult primary liver cancer. Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer. Eight types of standard treatment are used:

• Surveillance
• Surgery
• Liver transplant
• Ablation therapy
• Embolization therapy
• Targeted therapy
• Immunotherapy
• Radiation therapy

Follow up

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

External links

• NCI Liver Cancer Homepage

  Classification	ICD-10: C22.0 ICD-9-CM: 155 MeSH: D006528
  External resources	MedlinePlus: 000280 eMedicine: med/787

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