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Hepatocellular carcinoma (HCC, also called hepatoma) is a primary malignancy (cancer) of the liver. Most cases are secondary to either hepatitis infection (hepatitis B or C usually) or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis).
Treatment options and prognosis are dependent on many factors but especially on tumor size and staging.
In Sub-Saharan Africa the commonly accepted prognosis is a median survival of 3 months from diagnosis. However, this is due to late presentation with large tumours.
Epidemiology
HCC has two (very rough) patterns.
In some parts of the world - Sub-Saharan Africa and South-East Asia, especially Taiwan & China - it is the commonest cancer, generally affecting men more than women, and with an age of onset between late teens and 30's. This variability is in part due to the different patterns of Hepatitis B transmission in different populations - infection at or around birth (as in Taiwan) predispose to earlier cancers than if people are infected later.
In the west HCC is generally seen as rare cancer, normally of those with pre-existing liver disease. It is often detected by USS screening, and so presents to health-care facilities much earlier than in Sub-Saharan Africa, for example.
Diagnostics, Screening and Monitoring
The primary method of diagnosis is ultrasonography. Other imaging techniques used include computed axial tomography (CT scan) or magnetic resonance imaging (MRI).
Once imaged, diagnosis is confirmed by percutaneous biopsy.
Important features that guide treament include: -
- size
- spread (stage)
- involvement of liver vessels
- presence of a tumor capsule
- presence of extrahepatic metastases
- presence of daughter nodules
- vascularity of the tumor
MRI is the best imaging method to detect the presence of a tumor capsule.
Treatment
Most of the research done on HCC reflects a very 'western' population, which limits the applicability of published studies to much of the world.
- Surgery surgery to remove the tumor or liver transplantation can be use to treating small or slow-growing tumors if they are diagnosed early.
- Percutaneous Ethanol Injection (PEI) Among nonsurgical options, this is usually the treatment of choice for patients with small (3 cm or less in diameter) tumors.
- Transcatheter Arterial Chemoembolization (TACE) is usually perform in the treatment of large tumors (larger than 3 cm and less then 4 cm in diameter) most frequently performed by intraarterially injecting an infusion of antineoplastic agents mixed with iodized oil (such as Lipiodol).
- RadioFrequency Ablation (RFA) uses high frequency radio-waves to ablate the tumour.
- Combined PEI and TACE can used for tumors larger than 4 cm in diameter, although some Italian groups have had success with larger tumours using TACE alone.
Other treatments have been tried, including Tamoxifen, but none seem to have a great impact.
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