Hepatocellular Carcinoma

What Is Hepatocellular Carcinoma?

Hepatocellular carcinoma (HCC) is the medical term for the most common type of primary liver cancer, where cancer originates in the liver. It often develops in patients who have long-term liver diseases, such as cirrhosis (scarring of the liver), hepatitis B, or hepatitis C. HCC develops out of tumors, and it is responsible for roughly 12,000 deaths in the United States every year, which makes it one of the more serious types of cancer. However, hepatocellular carcinoma can be treated with early detection with surgery or a liver transplant.

Who Is at Risk for Developing Hepatocellular Carcinoma?

HCC is more prevalent in heavy drinkers and patients who accumulate fat in the liver. This can occur from drinking alcohol, or from nonalcoholic diseases, such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). People with long-standing chronic forms of hepatitis B and C are at risk as well. However, about 25 percent of hepatocellular carcinoma patients have no history of heavy drinking, cirrhosis, or other risk factors. Also, men over 60 are more likely to develop liver cancer than women or younger men.

What Are the Symptoms of Hepatocellular Carcinoma?

Early detection of liver cancer is imperative, but unfortunately, many patients don’t show symptoms until cancer begins to progress. Additionally, some liver cancer symptoms are similar to that of a number of gastrointestinal disorders, so they can be easily overlooked. Oftentimes, hepatocellular carcinoma is discovered while a physician is screening for a different condition. Some of the more common symptoms of HCC include:

• Persistent itching
• Unintended weight loss
• Gastrointestinal bleeding
• Jaundice (yellowing of the eyes and skin)
• Fever
• Abdominal discomfort 
• Distended stomach (enlarged stomach)
• Nausea and vomiting

How Is Hepatocellular Carcinoma Diagnosed?

Hepatocellular carcinoma might be suspected on imaging scans, such as CT and MRI if you are undergoing screening for a different type of gastrointestinal condition. If liver cancer is suspected, your doctor will order one or more types of tests to confirm it. People with cirrhosis are regularly monitored for signs of HCC with blood tests and imaging. Before any testing, your gastroenterologist will ask for your medical history and give you a physical exam. Diagnostic testing for hepatocellular carcinoma includes:

• Alpha-fetoprotein testing. Alpha-fetoprotein (AFP) is a protein that is produced by the liver but only in a fetus. By the time the child has reached one year of age, AFP levels are zero or close to zero. If AFP is present in adults, it is a tumor marker as it is often produced by liver tumors. The presence of AFP, particularly at rising levels, is a sign of hepatocellular carcinoma. The physician checks for AFP via a simple blood draw. If you are a patient at high risk for HCC (hepatitis, cirrhosis), then AFP levels are typically checked every several months.
• Imaging tests. Your physician may order imaging diagnostics to have the ability to see tumor growth on the liver. Imaging includes:
• Magnetic resonance imaging (MRI)
• Computed tomography scan (CT scan)
• Ultrasound
• Angiography (investigates the inside of organs and blood vessels)
• Liver biopsy. Taking a biopsy (tissue sample) from the liver is the most definitive way to diagnose hepatocellular carcinoma, but it is often the last diagnostic used. If your gastroenterologist sees tumors on your imaging tests, you have a high AFP level or both, that can be sufficient enough to make a definitive diagnosis. Liver biopsy is often used when other tests have been inconclusive.

How Is Hepatocellular Carcinoma Treated?

There are several methods used to treat hepatocellular carcinoma, and you and your physician will discuss what the best treatment for your case is. The most common type of treatment is surgical resection, but not all patients are good candidates for this. Other treatments include:

• Liver transplant 
• Radiation
• Transarterial chemoembolization
• Radiofrequency ablation

Surgical resection simply means the removal of the cancerous part(s) of the liver. If cirrhosis is not present, the liver has a much better chance of regeneration after the cancer is removed. Patients who are not good candidates for surgical resection include those with metastasized hepatocellular carcinoma (has spread to other organs), large tumors, or those with late-stage cirrhosis.

Having a liver transplant is another common treatment for HCC if a transplant is available. This type of surgery involves the removal of the entire liver, which is then replaced by a healthy one from a donor. Lifelong anti-rejection medication must be taken to ensure the new liver’s health.

Stereotactic body radiation therapy (SBRT) is the most common type of radiation used to treat liver cancer. This procedure is able to deliver high levels of radiation to tumors without destroying healthy tissues. It is used when a patient is not a good candidate for surgery or transplant.

Transarterial chemoembolization (TACE) stops blood flow to cancerous tumors and is used if a patient is not a good candidate for surgery or who is waiting for a transplant. Chemomobilization delivers drugs to the liver tumor, which stops blood flow and deprives it of oxygen. It is also used in patients with other cancer types that have metastasized to the liver.

Radiofrequency ablation (RFA) uses ultrasound to deliver extremely high heat to the tumor; at 90°C, the tumor begins to break down. This procedure can be performed during surgery or percutaneously (through the skin).

Can I Prevent Hepatocellular Carcinoma?

You can take some steps to lower your risk of developing liver cancer. These include:

• Avoiding large amounts of alcohol
• Maintaining a healthy weight
• Getting a hepatitis B vaccination 
• Being screened for hepatitis B and hepatitis C 

Hepatitis C is one of the primary risk factors for developing liver cancer, so if you suspect you’ve been exposed, talk to your healthcare provider about screening.