- Most common form of liver cancer
- 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
- Thus, early diagnosis is the most important step in managing HCC
- Risk factors include:
- Budd-Chiari syndrome
- Liver masses - regenerating nodules, hemangiomas, focal fat, dysplastic nodules, peliosis
- LFTs, CBC, BMP, GGT
- Initial contrasted CT
- Multiphasic contrasted CT and MRI non-emergently
- Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US
- Supportive, symptomatic treatment for complications and comorbidities
- Cirrhotic jaundice
- Hepatic encephalopathy
- Variceal bleeding
- Renal failure
- Extrahepatic metastases, most commonly bone, lung, abdominal viscera
- Paraneoplastic processes, such as hypoglycemia, hypocalcemia, polycythemia, feminization syndrome
- Watery diarrhea, dehydration are common in HCC with cirrhosis versus cirrhosis alone
- Discussion with oncologist for first time diagnosis
- Dependent on complications and comorbidities
- 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.
- Liver transplantation for hepatocellular carcinoma. Bismuth H, Majno PE, Adam R. Semin Liver Dis. 1999; 19(3):311-22.
- 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.
- Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.