Hepatocellular carcinoma


  • Most common form of liver cancer[1]
    • 5 new cases per 100,000 in western countries
    • > 100 per 100,000 in Southeast Asia and sub-Saharan Africa
  • Mean survival of 6-20 months, steady over the years despite progress in diagnosis and therapies directed at HCC
  • Surgical resection with transplantation, remains the best chance for cure
    • However, < 20% of patients meet criteria for resection at time of diagnosis[2]
    • Thus, early diagnosis is the most important step in managing HCC

Clinical Features

Differential Diagnosis

Liver mass[3]

  • Regenerating nodule
  • Hemangioma
  • Focal fat
  • Dysplastic nodules
  • Peliosis


Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis


Only bilirubin stains the sclera

  • Carotenemia
  • Quinacrine ingestion
  • Dinitrophenol, teryl (explosive chemicals)


Triphasic contrast CT of hepatocellular carcinoma.
  • Ultrasound
  • Initial contrasted CT
  • Multiphasic contrasted CT and MRI non-emergently
  • Biopsy
  • Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US[4]



  • Discussion with oncologist for first time diagnosis
  • Dependent on complications and comorbidities

See Also

External Links


  1. Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview. Pal S, Pande GK. J Hepatobiliary Pancreat Surg. 2001; 8(4):323-36.
  2. Liver transplantation for hepatocellular carcinoma. Bismuth H, Majno PE, Adam R. Semin Liver Dis. 1999; 19(3):311-22.
  3. Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation. Brancatelli G, Baron RL, Peterson MS, Marsh W. AJR Am J Roentgenol. 2003 Apr; 180(4):1007-14.
  4. Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.