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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 Carcinoma References

  1. Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011 Mar;53(3):1020-1022. doi: 10.1002/hep.24199. PMID: 21374666
  2. Chow PK, Choo SP, Ng DC, et al. National Cancer Centre Singapore Consensus guidelines for hepatocellular carcinoma. Liver Cancer. 2016 Apr;5(2):97-106. doi: 10.1159/000367759. PMID: 27386428
  3. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236. doi: 10.1016/j.jhep.2018.03.019. PMID: 29628281
  4. European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012 Apr;56(4):908-943. doi: 10.1016/j.jhep.2011.12.001. PMID: 22424438
  5. Heimbach JK, Kulik LM, Finn RS, et al. American Association for the Study of Liver Diseases (AASLD) guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018 Jan;67(1):358-380. doi: 10.1002/hep.29086.
  6. National Comprehensive Cancer Network. Hepatobilliary cancers. Version 1.2018. NCCN. https://www.nccn.org/. Feb 2018.
  7. Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017 Jul;11(4):317-370. doi: 10.1007/s12072-017-9799-9. PMID: 28620797
  8. Verslype C, Rosmorduc O, ESMO Guidelilnes Working Group, et al. Hepatocellular carcinoma: ESMO–ESDO Clinical practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012 Oct;23(Suppl 7):vii41-vii48. doi: 10.1093/annonc/mds225. PMID: 22997453
  9. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016 Mar;22(1):7-17. doi: 10.3350/cmh.2016.22.1.7. PMID: 27044761
  10. Cancer Research UK. BCLC staging system and the Child-Pugh system. Cancer Research UK. https://www.cancerresearchuk.org/. Jan 2019.
  11. Chen LT, Martinelli E, Cheng AL, et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with intermediate and advanced/relapsed hepatocellular carcinoma: a TOS-ESMO initiative endorsed by CSCO, ISMPO, JSMO, KSMO, MOS and SSO. Ann Oncol. 2020 Mar;31(3):334–351. doi:10.1016/j.annonc.2019.12.001. PMID: 32067677
  12. He MK, Le Y, Li QJ, et al. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer. 2017 Oct;36(1):83. doi: 10.1186/s40880-017-0251-2. PMID: 29061175
  13. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018 Aug;68(2):723–750. doi: 10.1002/hep.29913. PMID: 29624699
  14. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: hepatobiliary cancers. Version 4.2019. NCCN. https://www.nccn.org/. Dec 2019.
  15. Saeki I, Yamasaki T, Maeda M, et al. Treatment strategies for advanced hepatocellular carcinoma: Sorafenib vs hepatic arterial infusion chemotherapy. World J Hepatol. 2018 Sep;10(9):571–584. doi: 10.4254/wjh.v10.i9.571. PMID: 30310535
  16. Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct;29(Suppl 4):iv238–iv255. doi: 10.1093/annonc/mdy308. PMID: 30285213
  17. Cheng AL, Qin S, Ikeda M, et al. IMBrave 150: Efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC). Ann Oncol. 2019 Nov;30(Suppl 9):ix86-ix87.
  18. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology (NCCN guidelines): Hepatobiliary cancers. Version 2.2020. NCCN. https://www.nccn.org/. 08 May 2020.
  19. Yau T, Kang YK, Kim TK, et al. Nivolumab (NIVO) + Ipilimumab (IPI) combination therapy in patients with advanced hepatocellular (aHCC): Results from CheckMate 040. J Clin Oncol. 2019 May;37(Suppl 15):4012-4012. doi:10.1200/JCO.2019.37.15_suppl.4012.
  20. Benson AB, D'Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021 May;19(5):541-565. doi: 10.6004/jnccn.2021.0022. PMID: 34030131
  21. ClinicalKey. Clinical overview: hepatocellular carcinoma. ClinicalKey. https://www.clinicalkey.com. 27 Nov 2019.
  22. Ferrante ND, Pillai A, Singal AG. Update on the diagnosis and treatment of hepatocellular carcinoma. Gastroenterol Hepatol (N Y). 2020 Oct;16(10):506-516. PMID: 34017223
  23. Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline. J Clin Oncol. 2020 Dec;38(36):4317-4345. doi: 10.1200/JCO.20.02672. PMID: 33197225
  24. Mak D, Kramvis A. Epidemiology and aetiology of hepatocellular carcinoma in Sub-Saharan Africa. Hepatoma Res. 2021;7:39. http://dx.doi.org/10.20517/2394-5079.2021.15.
  25. Muthiah M, Chong CH, Lim SG. Liver disease in Singapore. Euroasian J Hepato-Gastroenterol. 2018;8(1):66-68.
  26. Stuart KE. Systemic treatment for advanced hepatocellular carcinoma. UpToDate. https://www.uptodate.com. 11 May 2021.
  27. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology: hepatobiliary cancers. Version 3.2021. NCCN. https://www.nccn.org/. 15 Jun 2021.
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