Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma is the most common form of liver cancer. Its an aggressive (fast-growing) cancer most common in people with advanced liver disease, like cirrhosis of the liver. Increasingly, people diagnosed with HCC have a liver condition that sometimes leads to cirrhosis called metabolic dysfunction-associated steatotic liver disease (MASLD).

In the beginning, hepatocellular carcinoma grows slowly. Surgery to remove the tumor or a liver transplant can treat HCC in its early stages. But most people dont learn they have it until its advanced and spreading more quickly. Eventually, it can lead to liver failure. At this point, HCC is challenging for providers to treat.

Symptoms and Causes

Symptoms

Tumors may not cause symptoms in the early stages. But as HCC progresses, you may notice:

• Fullness or a knot under your ribs on your right side (symptoms of an enlarged liver).
• Fullness under your ribs on your left side (symptoms of an enlarged spleen).
• Eyes and skin turning yellow (signs of jaundice).
• A stomach that feels swollen, like its filling up with fluid.
• Loss of appetite or feeling full after a small meal.
• Unexplained weight loss.
• Nausea and vomiting.
• Itching.

Causes

Most people diagnosed with HCC have cirrhosis of the liver (approximately 80%), although some have a condition that can lead to cirrhosis of the liver. In some instances, the condition never progresses to cirrhosis, but people still develop HCC. With these conditions, unmanaged long-term liver inflammation can lead to severe scarring and, eventually, HCC.

Risk factors for HCC

Hepatitis B and C infections, metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol use disorder all enhance your chance of developing HCC. If you are in a high-risk group, your healthcare physician may recommend regular screenings to detect HCC early, while it is treatable. They can also assist you in lowering risk factors, such as quitting smoking or drinking. They can help you manage chronic disorders that put your health at danger, such as hepatitis infections and diabetes.

Diagnosis

Your healthcare professional will perform a physical examination. They will also inquire about your medical history, symptoms, and lifestyle. The following tests can help confirm a diagnosis:

• Blood tests: Your doctor might perform a blood test to look for indicators of HCC, such as elevated alpha-fetoprotein (AFP) levels. A condition that might cause HCC, such as cirrhosis of the liver or a hepatitis infection, may be indicated by elevated AFP.
• Imaging scans: Imaging procedures such as an ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or angiography can detect cancers (or signs of a tumor) in your liver.
• Liver biopsy: To check for cancer cells, your doctor could perform a biopsy on a liver tumor. If your imaging scans and bloodwork findings aren't conclusive enough for a diagnosis, you could need this test.

Treatment

Treatment options include:

• Surgery: HCC can be treated surgically with a hepatectomy (the removal of the diseased section of the liver) or a liver transplant. If the tumor just affects one portion of your liver, you may be treated with a hepatectomy. If your liver is not healthy enough to undergo a hepatectomy, a liver transplant may be an alternative.
• Ablation therapy: Ablation providers use a specially designed needle to burn malignancies. The needle can direct energy that is highly hot (microwaves or radiofrequency waves) or extremely cold.
• Embolization: Embolization involves inserting a material directly into the arteries that supply the tumor, effectively blocking blood flow. Chemoembolization involves implanting a material containing chemotherapeutic medicines. Radioembolization is the process of implanting tiny radiation beads.
• Radiation therapy: For tiny tumors that cannot be removed surgically or destroyed by ablation, providers may suggest radiation therapy. To treat HCC, medical professionals employ a particular kind of radiation therapy called stereotactic body radiation therapy (SBRT).
• Immunotherapy: Immunotherapy drugs can also be used to treat advanced HCC. They help your immune system recognize and combat cancer cells.
• Targeted therapy: Advanced HCC is treated with targeted treatment medications. The signal that instructs cancer cells to continue growing is turned off by this treatment.

Prevention

There are several ways to lower your risk of developing HCC. You can do:

• Get the hepatitis B vaccine, or if you already have it, schedule regular check-ups.
• If you believe you have been exposed to hepatitis C, contact your doctor. (It can be cured with treatment.)
• Work with your doctor to manage the metabolic conditions that come with MASLD. Consuming nutritious foods is essential for maintaining a healthy weight.
• Reduce how much alcohol you consume.
• If you are a smoker, quit.

Conclusion

Hepatocellular carcinoma is a serious and often deadly form of liver cancer, most commonly occurring in individuals with chronic liver disease. Early detection through imaging and blood tests, combined with advances in treatment options, offers hope for improved outcomes. For those at risk, regular screening and managing underlying liver conditions are key to preventing HCC. As research into novel therapies and better diagnostic tools continues, the outlook for patients with hepatocellular carcinoma is expected to improve.