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Hepatocellular Carcinoma (HCC)
(Liver Cancer)
    
    
What is hepatocellular carcinoma?
  • 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
What does the liver do?
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
Main Types of Primary Liver Cancer
  • Hepatocellular carcinoma 75-85%
  • Intrahepatic cholangiocarcinoma (iCC) 10-15%
  • Combined HCC-cholangiocarcinoma (cHCC-CC) 1-5%
Causes
  • 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)
Risk Factors
  • 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
Additional Factors Linked with HCC
  • Obesity
  • Diabetes
Signs and Symptoms
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
Diagnosis
  • Ultrasound
  • CT (computed tomography) scan
  • MRI (magnetic resonance imaging)
  • Biomarkers:
    • AFP (alpha feta-protein)
    • DCP
    • CA19-9
Treatment
Discuss options with your physician.
  • Surveillance
  • Surgery
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Radiation
  • Embolization
  • Chemoembolization
  • Radioembolization
  • Ablation
  • Transplantation
Prevention
  • 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
Staging and Prognosis
  • 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
Clinical trials
References
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
 
Disclaimer: The information on this website is for educational purposes only. Please consult your doctor for professional medical advice.

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