Treatment Guideline Chart

Hepatocellular carcinoma is malignancy that originates from the liver.

It is usually asymptomatic for much of its natural history, however, symptoms such as jaundice, anorexia, weight loss, malaise and upper abdominal pain are seen in more advanced cases.

Physical signs are hepatomegaly and ascites. 

Liver cancer is the fourth most common cause of cancer-related mortality worldwide and hepatocellular carcinoma accounts for 75-90% of liver cancers.


Hepatocellular%20carcinoma Management


  • Multiphasic cross-sectional imaging (eg CT or abdominal MRI for liver assessment, chest CT and CT/MRI of the pelvis) is the preferred method for surveillance following treatment due to its reliability in assessing arterial vascularity that is associated with increased risk of HCC recurrence following treatment
    • Test should be done every 3-6 months for 2 years, then every 6-12 months 
  • Serum alpha-fetoprotein (AFP) levels are associated with poor prognosis following treatment and should be measured every 3-6 months for 2 years, then every 6-12 months
  • In the event of disease recurrence, re-evaluation according to the initial work-up should be considered
  • Refer to a hepatologist to discuss antiviral therapy for hepatitis carriers, if not previously done
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