Definition: Hepatocellular carcinoma is cancer that starts in the liver.
Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually diagnosed in people age 50 or older.
Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.
In most cases, the cause of liver cancer is long-term damage and scarring of the liver (cirrhosis). Cirrhosis may be caused by:
- Alcohol abuse
- Autoimmune diseases of the liver
- Hepatitis B or hepatitis C virus infection
- Inflammation of the liver that is long-term (chronic)
- Iron overload in the body (hemochromatosis)
People with hepatitis B or C are at high risk of liver cancer, even if they do not develop cirrhosis.
Symptoms of liver cancer may include any of the following:
- Abdominal pain or tenderness, especially in the upper-right part
- Easy bruising or bleeding
- Enlarged abdomen (ascites)
- Yellow skin or eyes (jaundice)
- Unexplained weight loss
The health care provider will perform a physical exam and ask about your symptoms. The physical exam may show an enlarged, tender liver or other signs of cirrhosis.
If the provider suspects liver cancer, tests that may be ordered include:
- Abdominal CT scan
- Abdominal MRI scan
- Abdominal ultrasound
- Liver biopsy
- Liver function tests
- Serum alpha fetoprotein
Some people who have a high chance of developing liver cancer may get regular blood tests and ultrasounds to see whether tumors are developing.
To accurately diagnose hepatocellular carcinoma, a biopsy of the tumour must be done.
Treatment depends on how advanced the cancer is.
Surgery may be done if the tumour has not spread. Before surgery, the tumor may be treated with chemotherapy to reduce its size. This is done by delivering the medicine straight into the liver with a tube (catheter) or by giving it intravenously (by IV).
Radiation treatments in the area of the cancer may also be helpful.
Ablation is another method that may be used. Ablate means to destroy. Types of ablation include using:
- Radio waves or microwaves
- Ethanol (an alcohol) or acetic acid (vinegar)
- Extreme cold (cryoablation)
A liver transplant may be recommended.
If the cancer can’t be surgically removed or has spread outside the liver, there is usually no chance for long-term cure. Treatment instead focuses on improving and extending the person’s life. Treatment in this case may use targeted therapy with drugs that can be taken as pills. Newer immunotherapy drugs may also be used.
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
If the cancer can’t be completely treated, the disease is usually fatal. But survival can vary, depending on how advanced the cancer is when diagnosed and how successful treatment is.
Call your provider if you develop ongoing abdominal pain, especially if you have a history of liver disease.
Preventive measures include:
- Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.
- Do not drink excessive amounts of alcohol.
- People with certain types of hemochromatosis (iron overload) may need to be screened for liver cancer.
- People who have hepatitis B or C or cirrhosis may be recommended for liver cancer screening.
Di Bisceglie AM, Befeler AS. Hepatic tumors and cysts. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 96.
National Cancer Institute website. Adult primary liver cancer treatment (PDQ) – health professional version. www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq. Updated March 24, 2019. Accessed August 27, 2019.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. Version 3.2019. www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Updated August 1, 2019. Accessed August 27, 2019.