What is hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It usually affects people aged 40 or older and it is the third deadliest cancer at a global level.

Prognosis

This type of cancer is often found in its most advanced stages, since the symptoms can be relatively subtle or very few in number in the early stages. This leads to a low survival rate. It is thus important that people who have a higher risk of getting this type of cancer (such as those who already have a chronic liver condition) are screened for it to catch the cancer early, when there is more chance of successfully treating it.

What are the symptoms of hepatocellular carcinoma?

Hepatocellular carcinoma can cause the following symptoms:

• A deep, dull pain and/or swelling in your abdomen
• Sudden weight loss together with loss of appetite and fatigue
• Vomiting, nausea, abdominal tenderness
• Enlarged liver (hepatomegaly)
• A high temperature
• Pain in the bones
• Jaundice (some cases)
• Enlarged spleen (rare)
• If you also have liver cirrhosis, you may notice a sudden worsening of this condition.

What causes HCC?

Causes for this type of cancer include:

• Cirrhosis (scarring of the liver) – this can be caused by alcohol abuse or infection with hepatitis B and C.
• Haemochromatosis – this disorder leads to an accumulation of iron in the liver and in other organs
• Dangerous or carcinogenic substances – can be found in some foods, e.g. nitrates or mycotoxins, or in the environment, e.g. arsenic and vinyl chloride monomer
• Long-term use of anabolic steroids

Secondary risk factors include smoking and obesity.

How can hepatocellular carcinoma be prevented?

It is essential that, if suffering from cirrhosis or any other liver condition, you are screened and have routine checks in order to catch cancer as early as possible.

To avoid exposure to hepatitis B and C (one of the biggest causes of liver cancer), you should:

• Get the vaccine for hepatitis B and C
• Avoid contact with other people’s bodily fluids – this includes not sharing toothbrushes, razors, or drug needles
• Practice safe sex
• If you get a piercing or a tattoo, you should only go to certified studio

Leading a healthier lifestyle can also help prevent HCC, so you should also eat a healthy diet and exercise regularly in order to maintain a healthy weight.

How is hepatocellular carcinoma treated?

Treatment options include:

• Surgical resection of the tumour – an option for early-stage liver cancer when liver function is normal, but it won't be possible if the cancer has already reached an advanced stage or if you have cirrhosis.
• Liver transplant – if a donor can be found, this is an option if the cancer has not spread beyond the liver.
• Radiotherapy can help shrink the tumour.
• Local chemotherapy: the drug is injected directly into the hepatic artery.
• Ablation therapy – uses extreme heat, cold, or radiofrequency energy to destroy cancerous cells via catheters.
• Chemoembolisation (TACE) – chemotherapy medication is injected into the cancer via a catheter.
• Percutaneous ethanol injection (PEI) – consists of injecting ethanol, which dehydrates the cancer cells.

Which medications should I take?

Some medications may be prescribed to disrupt the blood supply to cancerous cells and slow down the growth of the tumours. You should always follow your doctor’s instructions as to what medication to take for your individual case. Medications may be coupled with other treatments, such as chemoembolisation, liver transplant, radiofrequency ablation and surgery.

Which doctor should I talk to?

If you have a confirmed diagnosis of HCC, you may need to see a hepatologist, an oncologist and, in case you will have to undergo surgery, an oncological surgeon, too.