What is hepatocellular carcinoma (HCC)?

Primary liver cancer is cancer that starts in the liver. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Mr Satyajit Bhattacharya, a leading surgeon and liver cancer expert, explains what HCC is and how it is diagnosed and treated.

What is HCC?

The liver is made up of different types of cells, including liver cells (hepatocytes) and the cells that form bile ducts and blood vessels, and many more. Every type of cell in the liver has the potential to give rise to cancerous growths. Hepatocellular carcinoma (HCC) is cancer of the liver cells (hepatocytes). More than one tumour nodule can present within the liver, which is thought to be because one tumour spreads within the liver via the blood vessels. Once the tumour cells get into the blood stream, HCC can spread to the rest of the body. Tumour cells can also travel via the lymph vessels to the lymph glands underneath the liver.

What causes HCC?

HCC is most common in people with cirrhosis of the liver, however, it can also develop in people with healthy livers. Cirrhosis from various causes increases the risk of developing HCC, however, those with Hepatitis B and C are most at risk. Hence, HCC is most common in parts of the world where Hepatitis B and C are prevalent, including sub-Saharan Africa.

What symptoms does HCC cause?

HCC can be symptomless initially, with symptoms appearing in more advanced stages. The following can result:

• Jaundice
• Pain in the upper abdomen
• Low grade fever
• Weight loss
• Loss of appetite

In some cases a lump or the enlarged liver can be felt in the right hand side of the abdomen. In advanced stages, ascites can form (collections of fluid in the abdomen).

How is HCC diagnosed?

A diagnosis can be made with an ultrasound scan, which is confirmed with a CT scan. If there is any confusion about a diagnosis, an MRI scan, liver angiography and bone scan may be performed too. Blood can also be checked for Alpha Foeto Protein (AFP) levels as raised levels can indicate HCC, however, sometimes normal AFP levels can be found in patients with HCC, so it is not a reliable diagnosis method and will only be carried out in situations where it is necessary. Patients with cirrhosis or chronic Hepatitis B and C are surveyed regularly with ultrasound scans which often pick up early stage HCC.

What is the treatment for HCC?

Treatment for HCC depends on:

1. Tumour stage (number of nodules present, their size and location and whether they have spread to other organs, bones or lymph nodes)
2. Condition of the liver (whether it is healthy or if it has cirrhosis)
3. Age and fitness of the patient

In an otherwise healthy patient, the tumour can safely be surgically removed. If the tumour is large and cannot be removed safely, chemoembolization (TACE) can be considered which involves injecting anti-cancer drugs or radioactive substances into the artery that feeds the cancerous part of the liver. If the tumour is small, but the patient is either unfit or unwilling to go through surgery, then radiofrequency ablation (RFA) can be considered. This involves placing a needle into the tumour and destroying it with energy generated at the tip of the needle.

In otherwise healthy patients with a slightly disease liver, if the tumour is small then liver transplantation should be considered.

If the patient is not fit for surgery, and their liver is badly diseased or the tumour is large and has spread beyond the liver, then the focus of treatment should be controlling the symptoms. Chemotherapy (in the form of intravenous injections or tablets taken by mouth) is not hugely effective in HCC, nor is external beam radiation. Any new treatments offered to such patients should be within the context of a proper clinical trial.

If you would like to find out more, make an appointment with a specialist.