Hepatocellular Carcinoma (HCC) – Liver Cancer
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It typically develops in the context of chronic liver disease and requires early diagnosis and treatment.
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Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It typically develops in the context of chronic liver disease and requires early diagnosis and treatment.
What is Hepatocellular Carcinoma?
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and originates in the main liver cells, known as hepatocytes. It ranks among the most prevalent cancers worldwide and is one of the leading causes of cancer-related death. HCC predominantly affects adults and in most cases develops against a background of pre-existing chronic liver disease, particularly liver cirrhosis.
Causes and Risk Factors
The development of HCC is closely linked to various risk factors that lead to sustained liver damage:
- Chronic hepatitis B or C: Viral liver infections are the most common cause of HCC worldwide.
- Liver cirrhosis: Regardless of its underlying cause, cirrhosis significantly increases the risk of HCC.
- Alcohol-related liver disease: Chronic alcohol abuse causes liver damage that promotes cancer development.
- Non-alcoholic fatty liver disease (NAFLD) and NASH: An increasingly common cause in Western countries, often associated with obesity and type 2 diabetes.
- Aflatoxin exposure: Contamination of food with the mold toxin aflatoxin B1 is a major risk factor in certain regions of Africa and Asia.
- Haemochromatosis and other metabolic disorders: Genetic disorders affecting iron metabolism increase the risk of HCC.
Symptoms
In the early stages, hepatocellular carcinoma often causes no or only non-specific complaints. In advanced stages, the following symptoms may occur:
- Pain or pressure in the upper right abdomen
- Unexplained weight loss and loss of appetite
- General weakness and fatigue
- Yellowing of the skin and eyes (jaundice)
- Abdominal swelling due to fluid accumulation (ascites)
- Nausea and vomiting
Since many affected individuals already suffer from a known liver condition, changes are often attributed to the underlying disease, which can delay diagnosis.
Diagnosis
The diagnosis of HCC is established through a combination of imaging studies and laboratory tests:
Imaging
- Ultrasound (sonography): Recommended for surveillance in high-risk patients every 6 months.
- Contrast-enhanced CT or MRI: Allow precise assessment of the tumor, its location and extent. The typical HCC pattern (arterial enhancement with venous wash-out) is considered diagnostically characteristic.
Laboratory Values
- Alpha-fetoprotein (AFP): A blood tumor marker that may be elevated in HCC, though it is not always reliable on its own.
Biopsy
In ambiguous cases, a tissue sample (biopsy) may be required for histological confirmation of the diagnosis.
Staging
The most widely used staging system for HCC is the Barcelona Clinic Liver Cancer (BCLC) system. It takes into account tumor size and number, liver function, and the general condition of the patient, and serves as the basis for treatment planning.
Treatment
Treatment choices depend on the tumor stage, liver function, and the overall health of the patient.
Curative-Intent Therapies
- Surgical resection: Removal of the tumor by surgery; feasible when there is sufficient remaining liver function and limited tumor involvement.
- Liver transplantation: Considered potentially curative in selected patients (e.g., those meeting the Milan criteria).
- Ablative procedures: Thermal ablation using radiofrequency ablation (RFA) or microwave ablation for small, inoperable tumors.
Palliative Therapies
- Transarterial chemoembolisation (TACE): Interruption of the tumor blood supply combined with local chemotherapy delivery.
- Sorafenib and Lenvatinib: Targeted agents (tyrosine kinase inhibitors) used in advanced-stage disease.
- Immunotherapy: Checkpoint inhibitors such as atezolizumab in combination with bevacizumab have been established as effective first-line therapy in advanced HCC.
Prevention and Early Detection
Since HCC frequently arises in the context of known liver disease, regular surveillance examinations in high-risk patients are particularly important. Current recommendations include:
- Six-monthly liver ultrasound examinations in patients with cirrhosis or chronic hepatitis B
- Vaccination against hepatitis B for primary prevention
- Treatment of chronic hepatitis C with antiviral medications
- Reduction of alcohol consumption and body weight in patients with corresponding risk factors
References
- European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines - Management of hepatocellular carcinoma. Journal of Hepatology, 2018.
- World Health Organization (WHO): Cancer - Liver Cancer Fact Sheet. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer
- Llovet JM et al.: Hepatocellular carcinoma. Nature Reviews Disease Primers, 2021.
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Related search terms: Hepatocellular Carcinoma + Hepatocellular Cancer + HCC