Hepatocellular Carcinoma

Most common type of primary liver cancer

Aetiology

  • Occurs in the setting of chronic liver inflammation, and is most closely linked to chronic viral hepatitis infection (hepatitis B or C) or exposure to toxins such as alcohol

Clinical presentation

  • May present as primary presentation, worsening of pre-existing chronic liver disease or acute liver failure

Symptoms

  • Weight loss
  • RUQ pain
  • May be asymptomatic

Signs

  • Signs of cirrhosis
  • Hard enlarged RUQ mass
  • Liver bruit (rare)

Investigations

AFP (Alfa feto protein)

  • HCC tumour marker - elevation seen in 60-80% of patients

Imaging

  • USS
  • Triphasic CT scan
  • MRI

Biopsy

  • Nodular or infiltrative tumour

Management

Liver transplantation

  • Best available treatment
  • Only indicated if single tumour <5cm or <3 tumours <3cm each
  • Low recurrence

Resection

  • Small tumours with preserved liver function
  • Higher recurrence rate

Unresectable tumours

  • Radiofrequency ablation
  • Chemoembolisation (TACE)

Sorafenib

  • Survival advantage in advanced HCC
  • Side effects common