Hepatocellular Carcinoma (HCC)

Overview

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, meaning cancer that begins in the liver itself rather than spreading there from elsewhere. It arises from hepatocytes, the main working cells of the liver. Most cases develop in a liver that has already been injured over many years, usually by chronic hepatitis or cirrhosis (scarring).

Because the underlying liver disease and early cancer often cause few symptoms, HCC may not be noticed until it is advanced. People at high risk are often offered regular screening so it can be found earlier, when more treatment options are available.

Symptoms

Early HCC frequently causes no symptoms. As it grows or as liver function declines, signs may include:

• Pain or a lump in the upper right abdomen
• Unintended weight loss and loss of appetite
• Feeling full quickly when eating
• Yellowing of the skin and eyes (jaundice)
• Swelling of the abdomen from fluid buildup
• Fatigue, weakness, and easy bruising

Many of these overlap with symptoms of advanced liver disease. New or worsening jaundice, confusion, or significant bleeding should prompt urgent medical attention.

Causes

HCC develops when liver cells accumulate genetic damage, usually after years of chronic injury and inflammation. Leading contributors include:

• Chronic hepatitis B or C: Long-standing viral infection is a major worldwide cause.
• Cirrhosis: Scarring from any cause greatly raises the risk.
• Alcohol-related liver disease: Heavy, long-term alcohol use.
• Fatty liver disease: Linked to obesity, type 2 diabetes, and metabolic problems.
• Aflatoxins: Toxins from mold on improperly stored grains and nuts in some regions.

Risk Factors

• Chronic hepatitis B or hepatitis C infection
• Cirrhosis from any cause
• Heavy alcohol use
• Non-alcoholic fatty liver disease, obesity, and type 2 diabetes
• Long-term exposure to aflatoxins
• Certain inherited liver conditions, such as hemochromatosis

Diagnosis

Diagnosis often combines imaging with blood tests, and people at high risk may be screened regularly. Evaluation can include:

• Ultrasound: Frequently used for screening in people with cirrhosis or chronic hepatitis.
• CT or MRI: Detailed imaging that can often diagnose HCC by its appearance.
• Blood tests: Liver function tests and alpha-fetoprotein (AFP), a marker sometimes raised in HCC.
• Biopsy: A tissue sample, used when imaging is not conclusive.

Treatment

Treatment depends on the size and number of tumors, whether the cancer has spread, and how well the liver is working. Options include:

• Surgery: Removing the tumor when the liver is healthy enough.
• Liver transplant: Replacing the liver in selected people with early cancer and significant liver disease.
• Local treatments: Ablation (heat or other energy) and procedures that block the tumor's blood supply.
• Medications: Targeted therapy and immunotherapy for more advanced disease.
• Supportive care: Managing symptoms and complications of liver disease and improving quality of life.

Treating the underlying liver disease and avoiding further liver damage are important parts of care.

Prevention

• Get the hepatitis B vaccine and seek treatment for hepatitis B or C if infected
• Limit or avoid alcohol
• Maintain a healthy weight and manage diabetes to reduce fatty liver disease
• Attend regular liver cancer screening if you have cirrhosis or chronic hepatitis
• Avoid foods that may be contaminated with aflatoxins

When to See a Doctor

See a doctor for unexplained upper abdominal pain, weight loss, or yellowing of the skin or eyes, especially if you have liver disease. Seek emergency care for:

• Vomiting blood or passing black, tarry stools
• Sudden confusion or severe drowsiness
• Severe abdominal pain or rapidly worsening swelling
• Deepening jaundice with fever

Related Topics

Frequently Asked Questions

References

1. National Cancer Institute (NCI). Liver cancer treatment.
2. American Cancer Society. Liver cancer.
3. Mayo Clinic. Liver cancer — Symptoms and causes.
4. MedlinePlus, U.S. National Library of Medicine. Liver cancer.