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Understanding Hepatocellular Carcinoma: Causes, Symptoms, Diagnosis, and Treatment Options

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on October 15th, 2023.

Key Takeaways

  • This primary liver cancer accounts for 75% of all liver cancers globally and develops most commonly in patients with underlying cirrhosis—up to 90% of cases occur in cirrhotic livers.

  • Chronic hepatitis B infection increases risk 100-fold, while hepatitis C raises it 17-fold; both viruses cause progressive liver damage over 20-30 years before cancer develops.

  • Most patients remain asymptomatic until advanced stages, when 5-year survival drops to just 2%—explaining why high-risk individuals need ultrasound screening every 6 months.

  • Surgical resection offers 70% five-year survival when tumors are small and liver function is preserved, but only 10-15% of patients qualify at diagnosis.

  • Alpha-fetoprotein (AFP) blood levels above 400 ng/mL strongly suggest the diagnosis, though 40% of early-stage tumors have normal AFP levels.

Hepatocellular carcinoma is a type of cancer that starts in the liver. Unlike secondary liver cancers that have spread from other organs, hepatocellular carcinoma originates in the liver itself. Early detection is crucial, as it can sometimes be cured with surgery or transplant. In more advanced cases, treatment and support can help improve quality of life and extend survival.

Causes of Hepatocellular Carcinoma

While the exact causes of hepatocellular carcinoma are not always clear, several factors can increase the risk of developing this type of liver cancer:

  • Hepatitis B or hepatitis C infections

  • Cirrhosis (scarring of the liver)

  • Heavy alcohol consumption

  • Obesity and diabetes

  • Anabolic steroid use

  • Iron storage disease

  • Exposure to aflatoxin (a harmful substance produced by certain molds)

Symptoms of Hepatocellular Carcinoma

In its early stages, hepatocellular carcinoma may not cause any noticeable symptoms. As the cancer progresses, however, you may experience:

  • Pain in the upper right part of the abdomen

  • A lump or feeling of heaviness in the upper abdomen

  • Bloating or swelling in the abdomen

  • Loss of appetite and feelings of fullness

  • Weight loss

  • Weakness or deep fatigue

  • Nausea and vomiting

  • Yellowing of the skin and eyes (jaundice)

  • Pale, chalky stools and dark urine

  • Fever

Diagnosing Hepatocellular Carcinoma

To diagnose hepatocellular carcinoma, your doctor may perform a physical exam and ask about your symptoms. They may also recommend the following tests:

  • Blood tests to check for elevated levels of alpha-fetoprotein (AFP), a protein that can indicate liver cancer

  • Imaging tests, such as ultrasound, CT scan, or MRI, to look for tumors in the liver

  • Liver biopsy, which involves removing a small sample of liver tissue for examination under a microscope

Understanding Hepatocellular Carcinoma: Causes, Symptoms, Diagnosis, and Treatment Options

Treatment Options for Hepatocellular Carcinoma

Treatment for hepatocellular carcinoma depends on the stage of the cancer and the overall health of the patient. Options may include:

  • Radiation therapy (external or internal) to kill cancer cells

  • Chemotherapy, often delivered directly to the liver through a process called chemoembolization

  • Alcohol injection to destroy the tumor

  • Targeted therapy, which uses drugs to target specific changes in cancer cells

  • Immunotherapy to stimulate the immune system to fight cancer cells

  • Cryoablation or radiofrequency ablation to destroy the tumor using cold or heat

  • Partial hepatectomy, a surgery to remove the cancerous portion of the liver

  • Liver transplant, which may be an option if the cancer cannot be removed through partial hepatectomy

For more information on hepatocellular carcinoma, visit the American Cancer Society, the National Comprehensive Cancer Network, or the American Society of Clinical Oncology.

Managing Side Effects and Finding Support

During treatment, it's essential to take care of yourself and manage any side effects. This may involve adjusting your diet, getting enough rest, and finding ways to relax and cope with stress. Joining a support group can provide a valuable outlet for sharing your feelings and connecting with others who understand what you're going through.

Remember, you don't have to face this journey alone. Reach out to your healthcare team, family, and friends for the support you need. Together, you can navigate the challenges of hepatocellular carcinoma and make informed decisions about your care and quality of life.

The Bottom Line

Early detection through regular screening is crucial since symptoms typically appear only after the cancer has advanced significantly. If you have risk factors like hepatitis, cirrhosis, or concerning symptoms such as unexplained weight loss and abdominal pain, Doctronic can help you understand your next steps quickly.

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