• In children, it is called hepatoblastoma
• It is a primary liver cancer, a common tumour world-wide
• Third leading cancer death worldwide, the second leading cause of cancer death in men

The liver has four (4) lobes. It has many functions:

• Stores glycogen, vitamins and minerals
• Produces and excretes bile
• Metabolizes carbohydrates, fats and proteins
• Excretes bilirubin, cholesterol, hormones and drugs
• Purifies and detoxifies the blood
• Activates enzymes
• Synthesizes plasma proteins

• Hepatocellular carcinoma 75-85%
• Intrahepatic cholangiocarcinoma (iCC) 10-15%
• Combined HCC-cholangiocarcinoma (cHCC-CC) 1-5%

• Hepatitis B and C (chronic hepatitis)
• Alcoholic liver disease
• Non-alcoholic steatohepatitis (NASH)
• Non-alcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD)

• Hepatitis B and C
• Chronic inflammation in chronic hepatitis C
• NAFLD (MASLD) in the absence of history of alcohol
• Alcohol ingestion (30% of all cases)
• Aflatoxins
• Iron overload
• Glycogen storage disease
• Wilson disease
• Alpha one antitrypsin (AAT) disease
• Hypercitrullinemia
• Alagille syndrome
• Acute intermittent porphyrias

• Obesity
• Diabetes

May not experience any signs or symptoms in the early stages.

• Pain in the RUQ
• Lump on right side below ribs
• Nausea, Vomiting
• Loss of appetite
• Feeling full after a small meal
• Unexplained weight loss
• Ascites (abdominal swelling)
• Swelling in the legs and feet
• Fatigue, weakness
• Itching
• Easy bruising or bleeding
• Jaundice of eyes and skin
• Confusion, personality changes

• Ultrasound
• CT (computed tomography) scan
• MRI (magnetic resonance imaging)
• Biomarkers:
• AFP (alpha feta-protein)
• DCP
• CA19-9

Discuss options with your physician.

• Surveillance
• Surgery
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Radiation
• Embolization
• Chemoembolization
• Radioembolization
• Ablation
• Transplantation

• Vaccination for Hepatitis B
• Prevent spread of Hepatitis C
• Alcohol consumption less than 2 drinks per week
• Exercise or physical activity
• No smoking
• Nutritional (well-balanced) diet

• 5 stages
• Staging based on the Barcelona clinic Liver Cancer (BCLC) system
• Prognosis is dependent on stage, health of individual and response of cancer to treatment: no specific Canadian statistics available

• World wide clinical trials: https://www.clinicaltrials.gov
• Canadian trials (CAPTUR): https://clinicaltrials.gov/ct2/show/NCT03297606

• Printable PDF brochure about HCC

Amaro, C.P., Allen, M.J., Knox, J.J., Tsang, E.S., Lim, H.J., Lee-Ying, R.M., … Tam, V. (2022). Dosing, efficacy and safety of lenvatinb in the real-world treatment of hepatocellular carcinoma: Results from a Canadian database. Liver Cancer International. 3(3) 119-127. https://doi.org/10.1002/lci2.59

Asafo-Agyei, K.O. & Samant, H. (2023). Hepatocellular carcinoma. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK559177/

Canadian Cancer Society (2023). Liver cancer. Retrieved from: https://cancer.ca/en/cancer-information/cancer-types/liver

Canadian Cancer Society (2023). Targeted therapy. Retrieved from: https://cancer.ca/en/treatments/treatment-types/targeted-therapy

Canadian Centre on Substance Abuse and Addiction (2023). Retrieved from: https://www.ccsa.ca

Canadian Liver Foundation (2023). Liver cancer and tumours. Retrieved from: https://www.liver.ca/patients-caregivers/liver-diseases/liver-cancer/

Gao, Y-X., Yang, T-W., Yin, J-M., Yang, P-X., Kou, B-X., Chai, M-Y., Liu, X-N., Chen, D-X. (2020). Progress and prospects of biomarkers in primary liver cancer (review). International Journal of Oncology. pp 54-66. Retrieved from https://doi.org/10.3892/ijo.2020.5035

Mansouri, V., Razzaghi, M., Nikzamir, A., Ahmadzadeh, A., Iranshahi, M., Haghazali, M., & Hamdieh, M. ((2020). Assessment of liver cancer biomarkers. Gastroenterology and Hepatology from Bed to Bench. 13(Suppl. 1), S29-S39. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881406/pdf/GHFBB-13-S29.pdf

National Cancer Institute (2021). Advances in liver and bile duct research. Retrieved from: https://www.cancer.gov