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


  • 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

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


  • 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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Hepatology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 5 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
5 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.