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Hepatocellular Cancer

Table of Contents
1 Disease Overview
2 Symptoms and diagnosis
3 Treatment

Disease Overview

    Globally, hepatocellular cancer is the fifth most common cancer and primarily arises from hepatitis B and C infections. Patients with cirrhosis should be monitored every 6 months as diagnosis of the disease in its early stages may be treated with resection, liver transplantation, or percutaneous treatment. Other well known risk factors for hepatocellular cancer includes excessive alcohol consumption, androgenic steroids, tobacco, aflatoxins, nitrosylated compounds, thorotrast, hemochromatosis, Wilson disease, and porphyria.

Symptoms and diagnosis

    Hepatocellular cancer is graded as well differentiated, moderately well differentiated, and poorly differentiated, and is pathologically distinguished between fibrolamellar variant and hepatocellular cancer. Fibrolamellar carcinoma (FLC) is typically found in children and young adults and is usually dissociated with chronic liver disease. Prognosis of patients with FLC is generally better than those with hepatocellular carcinoma due to a lack of cirrhosis and younger age at presentation and is thus usually resectable. Patients with hepatocellular carcinoma, however, are generally found in men older than 65 with less than 25% of tumours being resectable. Patients at high risk for hepatocellular carcinoma are usually monitored with imaging tests; however, due to the similarity in appearance between cirrhotic and cancerous livers, biopsies are often needed to differentiate the two.

Treatment

Hepatocellular Cancer (HCC) Treatment Algorithm

ASCO Sep 4th edition, 2014

    Standard treatment for patients with hepatocellular cancer is surgical resection, although often, this is not possible. Generally, this disease is unresponsive to systemic chemotherapy. Instead, percutaneous ablation of tumours less than 3 cm in diameter produces complete response from 80% of patients, whereas percutaneous ablation of tumours from 3 to 5 cm in diameter produces a complete response in only 50% of patients. However, because most hepatocellular carcinomas present with cirrhosis, percutaneous ablations will not change overall survival.

    Liver transplantation is an excellent treatment option for patients with significant cirrhosis and tumours within the Milan criteria (single tumour ≤ 5 cm in size or ≤ 3 tumours each ≤ 3 cm in size, and no macrovascular invasion).

    In advanced hepatocellular carcinoma (stage III), sorafenib is associated with an increase in overall response and survival.