Hepatocellular%20carcinoma Signs and Symptoms

• Cancer originating from the liver

Types of Hepatocellular Carcinoma by Morphology

• Nodular: Characterized by nodules that are well-circumscribed and often associated with cirrhosis
• Massive: Occupies a large area that may or may not have satellite nodules in the surrounding liver; usually associated with noncirrhotic liver
• Diffuse: Less common type; characterized by diffuse involvement of many small indistinct tumor nodules throughout the liver

• Physical signs are hepatomegaly and ascites
• Usually asymptomatic for much of its natural history
• Nonspecific symptoms include:
  
  • Jaundice
  • Anorexia
  • Weight loss
  • Malaise
  • Upper abdominal pain

• Presence of cirrhosis is the key risk factor for the development of hepatocellular carcinoma

High-risk Groups for Hepatocellular Carcinoma Screening and Surveillance

• Asian male ≥40 years old who are hepatitis B carriers
• Asian female ≥50 years old who are hepatitis B carriers
• Hepatitis B carriers with family history of hepatocellular carcinoma
• Africans and African Americans with hepatitis B
• Cirrhotic hepatitis B and C carriers
• Alcoholic cirrhosis
• Nonalcoholic fatty liver disease
• Individuals with stage 4 primary biliary cirrhosis
• Individuals with genetic hemochromatosis and cirrhosis
• Individuals with alpha 1-antitrypsin deficiency and cirrhosis
• Individuals with cirrhosis from other etiologies
• Environmental exposure to aflatoxin which is a natural product of the Aspergillus fungus found in various grains

• Liver cancer is the second most common cause of cancer-related mortality worldwide and hepatocellular carcinoma accounts for >90% of liver cancers
  • It is the sixth most common cancer worldwide; 5th most common in males and 9th most common in females
  • In Singapore, from 2009-2013, it is the 3rd most common cause of cancer death in males and 4th in females
  • About 83% of new hepatocellular carcinoma cases in 2012 occurred in less developed countries with East and South Asia and Saharan Africa having the highest incidence; Northern Europe and South Central Asia have the lowest incidence
  • Asia has the highest incidence of hepatocellular carcinoma relative to blacks, Hispanics and whites
  • 71% of reported hepatic cancers worldwide are from Eastern (55.6%), South-Eastern (10.6%) and South-Central(5.2%) Asia

• There is a >2:1 ratio of male-to-female predominance
• Approximately 80% of hepatocellular carcinoma cases are caused by hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection especially in those with cirrhosis