Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third most common cause of cancer worldwide. Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.

The main risk factor for developing HCC is liver cirrhosis, for example secondary^ to hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis. Other risk factors include:

• alpha-1 antitrypsin deficiency
• hereditary tyrosinosis
• glycogen storage disease
• aflatoxin
• drugs: oral contraceptive pill, anabolic steroids
• porphyria cutanea tarda
• male sex
• diabetes mellitus, metabolic syndrome

Features

• tends to present late
• features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
• possible presentation is decompensation in a patient with chronic liver disease
• raised AFP

Screening with ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as:

• patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
• men with liver cirrhosis secondary to alcohol

Management options