Published: 18 Jun 2025

ICD9: 155.0      ICD10: C22.0      ICD11: 2C12.0

Hepatocellular carcinoma (HCC), also known as hepatoma, is the most common type of liver cancer.
It develops from the liver's main cells, called hepatocytes. Here's a breakdown:

Key Aspects of Hepatocellular Carcinoma (HCC):

Origin: Arises from the hepatocytes, the functional cells of the liver.
Prevalence: The most frequent type of primary liver cancer (cancer that starts in the liver).
Association: Strongly linked to chronic liver diseases like cirrhosis (scarring of the liver), hepatitis B and C infections, alcohol abuse, non-alcoholic fatty liver disease (NAFLD), and hemochromatosis (iron overload).

Causes and Risk Factors:

Chronic Viral Hepatitis: Hepatitis B (especially in regions where vaccination rates are low) and Hepatitis C are major risk factors. They cause chronic inflammation and liver damage, increasing the likelihood of HCC.
Cirrhosis: Scarring of the liver due to any cause (alcohol abuse, viral hepatitis, NAFLD, etc.) significantly increases the risk. Cirrhosis changes the liver's structure and function, making it vulnerable to cancer development.
Alcohol Abuse: Excessive alcohol consumption damages the liver and leads to cirrhosis, raising HCC risk.
Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): NAFLD and its more severe form, NASH, are increasingly common, especially in people with obesity, diabetes, and high cholesterol. These conditions can lead to cirrhosis and HCC, even without alcohol consumption.
Aflatoxins: These are toxins produced by certain molds that can contaminate food crops like peanuts, corn, and grains. Long-term exposure increases the risk of HCC.
Hemochromatosis: This genetic condition causes the body to absorb too much iron, which can damage the liver and increase HCC risk.
Other Liver Diseases: Primary biliary cholangitis and autoimmune hepatitis are less common but can still raise the risk.
Obesity and Diabetes: Increase the risk of NAFLD/NASH which can lead to HCC.
Smoking: Increases the risk of HCC, especially when combined with other risk factors.

Symptoms:

Early-stage HCC often has no symptoms. As the cancer grows, symptoms may include:

Abdominal Pain: Often in the upper right abdomen.
Abdominal Swelling (Ascites): Fluid buildup in the abdomen.
Jaundice: Yellowing of the skin and eyes.
Unexplained Weight Loss: Losing weight without trying.
Loss of Appetite: Feeling less hungry than usual.
Nausea and Vomiting: Feeling sick to your stomach.
Weakness and Fatigue: Feeling tired and weak.
Enlarged Liver: The liver may feel larger than normal during a physical exam.
Enlarged Spleen: The spleen may also be enlarged.
Itching: Generalized itching without a rash.
Changes in Bowel Habits: Diarrhea or constipation.
Fever: Unexplained fever.

Diagnosis:

Blood Tests: Liver function tests (LFTs) and alpha-fetoprotein (AFP) levels. AFP is a tumor marker that can be elevated in HCC.
Imaging Tests:
Ultrasound: Often used as an initial screening tool.
CT Scan: Provides detailed images of the liver.
MRI: Another detailed imaging technique, often used to characterize liver lesions.
Liver Biopsy: A small sample of liver tissue is taken and examined under a microscope. This is often necessary to confirm the diagnosis of HCC.

Staging:

HCC is staged to determine the extent of the cancer. Staging systems, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, consider factors like tumor size, number of tumors, presence of vascular invasion, and liver function. The stage helps guide treatment decisions and predict prognosis.

Treatment:

Treatment options depend on the stage of the cancer, the overall health of the patient, and the liver's function. Options include:

Surgery:
Liver Resection: Removal of the cancerous portion of the liver. Suitable for patients with good liver function and localized tumors.
Liver Transplantation: Replacing the diseased liver with a healthy donor liver. An option for some patients with advanced cirrhosis and HCC that meets specific criteria.
Ablation Therapies: Destroying the tumor with heat or chemicals.
Radiofrequency Ablation (RFA): Uses heat to kill cancer cells.
Microwave Ablation (MWA): Similar to RFA, but uses microwaves.
Ethanol Injection: Injecting alcohol into the tumor to destroy it.
Transarterial Chemoembolization (TACE): Delivering chemotherapy drugs directly into the artery supplying the tumor, followed by blocking the artery to cut off the tumor's blood supply.
Radiation Therapy: Using high-energy rays to kill cancer cells.
Targeted Therapy: Drugs that target specific molecules involved in cancer cell growth and survival. Examples include sorafenib and lenvatinib.
Immunotherapy: Drugs that help the body's immune system fight cancer. Examples include pembrolizumab and nivolumab.
Clinical Trials: Participating in clinical trials may offer access to new and experimental treatments.

Prevention:

Hepatitis B Vaccination: Crucial for preventing hepatitis B infection and reducing HCC risk.
Hepatitis C Screening and Treatment: Screening for hepatitis C and treating those infected can prevent cirrhosis and HCC.
Limit Alcohol Consumption: Reducing or eliminating alcohol intake can prevent liver damage.
Maintain a Healthy Weight: Preventing obesity and managing diabetes can reduce the risk of NAFLD/NASH.
Avoid Aflatoxins: Proper food storage and handling practices can minimize exposure to aflatoxins.
Screening: Regular screening for HCC is recommended for people with cirrhosis or chronic hepatitis B. Screening typically involves ultrasound and AFP blood tests every 6 months.

Prognosis:

The prognosis for HCC varies depending on the stage of the cancer, the patient's overall health, and the treatment received. Early detection and treatment can improve the chances of survival.

In summary: HCC (Hepatocellular Carcinoma), or Hepatoma, is a serious liver cancer predominantly caused by chronic liver conditions. Early detection and appropriate treatment are crucial for improving outcomes. Prevention through vaccination, lifestyle modifications, and screening programs plays a significant role in reducing the incidence of HCC.