hepatocellular%20carcinoma
HEPATOCELLULAR CARCINOMA

Hepatocellular carcinoma is malignancy that originates from the liver.

Physical signs are hepatomegaly and ascites. It is usually asymptomatic for much of its natural history.

Liver cancer is the second most common cause of cancer-related mortality worldwide & hepatocellular carcinoma accounts for >90% of liver cancers.

 

Hepatocellular%20carcinoma Signs and Symptoms

Definition

  • Cancer originating from the liver

Pathology

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

Signs and Symptoms

  • 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

Risk Factors

  • 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

Epidemiology

  • 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
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