hepatocellular carcinoma

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma (HCC) is a type of cancer that starts in the liver. It is the most common type of primary liver cancer, accounting for approximately 90% of all liver cancers [1]. HCC occurs when abnormal cells in the liver grow and multiply uncontrollably, forming a tumor.

Causes and Risk Factors

HCC can occur in anyone, but it is more common in people with certain risk factors, such as:

• Chronic hepatitis B or C infection
• Cirrhosis (scarring of the liver)
• Liver damage from excessive alcohol consumption
• Exposure to aflatoxins (toxins produced by moldy grains and nuts)
• Family history of HCC

Symptoms

In its early stages, HCC may not cause any noticeable symptoms. However, as the tumor grows, it can lead to a range of symptoms, including:

• Abdominal pain or discomfort
• Weight loss
• Fatigue
• Loss of appetite
• Yellowing of the skin and eyes (jaundice)
• Swelling in the abdomen

Treatment Options

The treatment for HCC depends on the stage and severity of the cancer. Treatment options may include:

• Surgical removal of the tumor
• Liver transplantation
• Chemotherapy or targeted therapy to slow down the growth of the tumor
• Radiation therapy to relieve symptoms and improve quality of life

Prognosis

The prognosis for HCC patients varies depending on the stage and severity of the cancer. Early detection and treatment can significantly improve survival rates.

References:

[1] Apr 28, 2023 — Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. [2] May 7, 2024 — Hepatocellular carcinoma is the most common type of liver cancer and usually occurs in people with hepatitis B and hepatitis C infections. [3] Oct 14, 2024 — Hepatocellular carcinoma (HCC) is a primary malignancy of the liver.

Hepatocellular carcinoma (HCC) is a type of liver cancer that can cause various signs and symptoms, which may vary from person to person.

Common symptoms of HCC include:

• Unintended weight loss [5]
• Loss of appetite or feeling full after eating a small meal [6][8]
• Pain in the right upper abdomen or shoulder blade [7]
• Weakness and tiredness [5]
• Swelling of the abdomen due to a build-up of fluid (ascites) [5]

Other symptoms may include:

• Nausea and vomiting [1][2][8]
• Pale, chalky bowel movements and dark urine [6]
• Fever [3]
• Enlarged veins on the belly that can be seen through the skin [3]
• Abnormal bruising or bleeding [3]

It's worth noting that:

• Many people with HCC do not experience any symptoms in the early stages of the disease.
• Some individuals may only experience mild symptoms, which can make diagnosis challenging.

References:

[1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [5] - Context result 5 [6] - Context result 6 [7] - Context result 7 [8] - Context result 8

Diagnostic Tests for Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is a type of liver cancer that requires accurate diagnosis to determine the best course of treatment. Various diagnostic tests can help identify HCC, and here are some of them:

• Imaging Tests: Imaging modalities such as CT scan [3], MRI [4], and ultrasound [9] are commonly used to diagnose HCC. These tests can detect tumors in the liver and provide information on their size, location, and number.
• Blood Tests: Blood tests may reveal liver function abnormalities, which can indicate the presence of HCC [8]. However, these tests alone may not be definitive enough for a diagnosis.
• Liver Biopsy: A liver biopsy offers a definitive diagnosis but may not be necessary in all cases. If your AFP level is significantly elevated and your doctor sees a tumor on an imaging test, a biopsy may not be required [7].
• Positron Emission Tomography (PET) Scan: A PET scan can also be used to diagnose HCC, especially when other tests are inconclusive [4].

Staging Process

Some of the tests and procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process. This helps determine the extent of the disease and guide treatment decisions.

References:

• [1] ES Bialecki · 2005 - Diagnosis of HCC often requires more sophisticated imaging modalities.
• [2] Apr 1, 2019 - Sometimes, the only way to be sure that liver cancer is present is to take a biopsy.
• [3] Oct 14, 2024 - The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging.
• [4] May 15, 2024 - Some of the tests and procedures used to diagnose liver cancer may be used in the staging process.
• [5] by MH Attwa · 2015 - Core tip: This review aims to spotlight on the different diagnostic modalities, and treatment options of hepatocellular carcinoma (HCC).
• [6] You may need this test if your bloodwork results and imaging scans aren't definitive enough for a diagnosis.
• [7] A liver biopsy offers a definitive diagnosis but may not be necessary.
• [8] Apr 28, 2023 - Tests and procedures used to diagnose liver cancer include: Blood tests.
• [9] by JM Schwartz · Cited by 10 - Selection of imaging exam · Modalities for HCC diagnosis.

Treatment Options for Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is a type of liver cancer that requires effective treatment to manage its progression. The following are some of the key drug treatments used in the management of HCC:

• Sorafenib: Sorafenib was the first multikinase inhibitor introduced as a treatment option for HCC in 2007 [1]. It targets various pathways involved in tumor growth and angiogenesis, making it an effective systemic therapy for advanced disease [3].
• Regorafenib: Regorafenib became the first agent approved by the FDA as a second-line therapy for patients with advanced HCC who progressed on sorafenib [8]. It is also a multikinase inhibitor that targets various pathways involved in tumor growth and angiogenesis.
• Atezolizumab and Bevacizumab: These are becoming the standard of care for curative, first-line systemic treatment options for HCC [9]. Atezolizumab is an anti-PD-L1 antibody that targets the PD-1/PD-L1 axis, while bevacizumab is a monoclonal antibody against VEGF.

Targeted Therapy

Targeted therapy drugs attack specific weaknesses in cancer cells and may help slow disease progression. Sorafenib was one of the first targeted therapies used to treat advanced HCC [7]. It targets the VEGF pathway, which plays a crucial role in tumor angiogenesis.

New Therapies on the Horizon

With the advancement of research, new targeted therapies and immunotherapies are being explored for the treatment of HCC. These include atezolizumab and bevacizumab, which have shown promising results as first-line treatments [9].

References:

[1] MY Feng (2022) - Sorafenib was the first multikinase inhibitor introduced in 2007 as a treatment option for HCC.

[3] Oct 14, 2024 - For many years, sorafenib has been the only systemic therapy option for advanced disease.

[7] Apr 14, 2023 - One of the first treatments for treating advanced hepatocellular carcinoma was a targeted therapy drug called sorafenib.

[8] by XY Luo (2021) - Regorafenib became the first agent approved by the FDA as a second-line therapy for patients with advanced HCC who progressed on sorafenib.

[9] Aug 8, 2020 - Curative, first-line systemic treatment options for HCC include atezolizumab and bevacizumab.

Differential Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in cirrhosis [3]. However, differential diagnosis is crucial to rule out other conditions that may present similarly. Here are some key points to consider:

• Dysplastic nodules: These are small, well-circumscribed lesions that can be difficult to distinguish from HCC. They often have a similar appearance on imaging studies [1].
• Fibrous nodular hyperplasia: This is a rare condition characterized by the growth of fibrotic tissue in the liver, which can mimic HCC on imaging studies [5].
• Metastatic disease: Tumors from other parts of the body, such as the breast or colon, can metastasize to the liver and be mistaken for HCC [2].
• Primary hepatic lymphoma: This is a rare type of cancer that affects the liver and can present similarly to HCC [1].

Key Diagnostic Features

To differentiate HCC from these conditions, several key features should be considered:

• Imaging characteristics: HCC often shows arterial-phase enhancement and venous-phase washout on imaging studies, whereas other conditions may have different patterns of enhancement [8].
• Clinical presentation: Patients with HCC often present with symptoms such as abdominal pain, jaundice, and weight loss, which can also be seen in other liver diseases [4].
• Laboratory findings: Elevated alpha-fetoprotein (AFP) levels are commonly seen in HCC, but not always present [7].

Conclusion

Differential diagnosis of hepatocellular carcinoma is essential to ensure accurate diagnosis and treatment. By considering the key points outlined above, healthcare providers can make informed decisions about patient care.

References:

[1] Oct 14, 2024 - Diagnostic Considerations · Dysplastic nodules in cirrhosis · Fibrous nodular hyperplasia · Metastatic disease · Primary hepatic lymphoma ...

[2] by U Drebber · 2006 · Cited by 8 — Differential diagnosis has to be considered for such hepatic tumors as adenoma and precancerous lesions such as dysplastic nodules or mesenchymal tumors.

[3] by JM Schwartz · Cited by 10 — Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in ...

[4] Jul 29, 2020 — Hepatocellular carcinoma must be differentiated from other diseases that cause abdominal pain, jaundice, and weight loss, such as liver ...

[5] Oct 10, 2024 — Imaging differential diagnosis. Focal nodular hyperplasia. Hepatic adenoma. Undifferentiated embryonal sarcoma in adult. Hepatic carcinoid.

[6] by I Barshack · 2010 · Cited by 65 — The differential diagnosis of liver tumor includes the discrimination of HCC and metastases to the liver. A related and common clinical conundrum is the ...

[7] by HY Tian · 2024 · Cited by 2 — Purpose: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver cancers with different therapeutic methods and prognoses.

[8] by M Anis · 2011 · Cited by 22 — Hepatocellular cancer is most commonly seen in patients with cirrhosis. Criteria for diagnosis include arterial-phase enhancement, venous-phase washout, and a ...