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Survival rates for hepatocellular carcinoma (HCC) are poor. The cancer is usually diagnosed in advanced stages
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. It occurs most often in people with other liver disorders and frequently occurs secondary to hepatitis B and C infections.
Hepatocellular carcinoma has a poor prognosis for survival. The cancer is usually diagnosed in advanced stages because there are usually no symptoms in initial stages.
Most studies report that patients with smaller, removable tumors who do not have cirrhosis or other serious health problems have the best outlook post-surgery. Early stage liver cancer with a liver transplant has a 5-year survival rate of about 60%-70%.
Localized (cancer is limited to the liver)
34%
Regional (cancer has spread to nearby structures and lymph nodes)
12%
Distant (cancer has already spread to the liver, lungs, and bones)
3%
All SEER stages combined
20%
Data is from the American Cancer Society
What are risk factors for HCC?
Risk factors for HCC include:
- Chronic liver disorders
- Hepatitis B or C infections
- Alcohol consumption
- Liver cirrhosis
- Diabetes mellitus
- Obesity
- Hemochromatosis
- Wilson's disease
- Increased exposure to vinyl chloride
Hepatocellular carcinoma is more commonly seen in men than women and typically occurs between the ages of 40-60.
What are the signs and symptoms of HCC?
The most common and earliest symptom of hepatocellular carcinoma is hepatosplenomegaly, which is associated with pain in the abdomen. Jaundice is a late sign of hepatocellular carcinoma.
Tumor markers of hepatocellular carcinoma include:
- Alpha-fetoprotein
- Glypican
- HepPar-1
- Protein induced by vitamin K
- Protein induced by vitamin K antagonist II
How is hepatocellular carcinoma diagnosed?
Early diagnosis of hepatocellular carcinoma can be made through tests such as:
- Blood tests (a complete blood count should be done to look for the levels of neutrophils, eosinophil, leucocytes, lymphocytes, and monocytes)
- Computed tomography, magnetic resonance imaging, etc.
- Liver biopsy (trucut biopsy is preferred)
The imaging study of choice for hepatocellular carcinoma is triple-phase computed tomography, which can help differentiate it from other metastases.
What are treatment options for hepatocellular carcinoma?
Treatment for hepatocellular carcinoma depends on whether the cancer is localized or advanced.
Surgery
With localized hepatocellular carcinoma, FibroScan is used to measure functional liver reserve, which is normally over 25%. The following procedures are done depending on the functional liver reserve:
- Tumor resection: If the tumor is small with adequate functional liver reserve
- Liver transplant: If functional liver reserve is low
- ALPPS procedure (associated liver partition and portal vein ligation for staged hepatectomy): If the tumor is small and the functional reserve is inadequate
Milan tumors can be a single tumor of 5 cm or multiple tumors smaller than 3 cm. It doesn't metastasize, and there is no lymphovascular invasion.
Targeted drug therapy
Targeted drug therapy detects weakness in certain cancer cells and attacks them. This is helpful in slowing down the progression of disease in people with advanced liver cancer.
Radiation therapy
If surgery is not an option, radiation therapy may be recommended. A special type of radiation called stereotactic body radiotherapy involves focusing multiple beams simultaneously on one part of the body.
Immunotherapy
These drugs enhance and strengthen the immune system to fight cancer cells. This is a good option for people with advanced hepatocellular carcinoma.
Palliative treatment
Advanced hepatocellular carcinoma is managed with palliative treatment that includes:
- Trans arterial chemo embolization
- Trans arterial radio embolization using yttrium spheres
- Radiofrequency ablation
- High-frequency ultrasonic therapy
Clinical trials
There are several ongoing clinical trials for hepatocellular carcinoma that may help doctors explore new areas in the treatment of the disease and improve outcomes.
