Hepatocellular carcinoma (HCC)

Overview

Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer, originating in the hepatocytes, which are the main functional cells of the liver. HCC is notably aggressive and often diagnosed at an advanced stage due to its subtle symptoms in the early phases. The liver is a critical organ responsible for various essential functions, including detoxification, metabolism, and protein synthesis. Chronic liver diseases, particularly cirrhosis resulting from chronic hepatitis B or C infections, are major risk factors for developing HCC. The global incidence of HCC has been rising, underscoring the importance of early detection and effective management.

Types of Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma can be classified into several types based on its histological features:

1. Classic Hepatocellular Carcinoma

   • This is the most common form, characterized by a distinctive pattern of liver cell proliferation and tumor formation.

2. Fibrolamellar Hepatocellular Carcinoma

   • A rarer subtype that typically affects younger individuals and is known for its unique fibrous bands within the tumor.

3. Mixed Hepatocellular-Cholangiocarcinoma

   • A type that exhibits features of both hepatocellular carcinoma and cholangiocarcinoma, a cancer of the bile ducts.

4. Hepatoblastoma

   • Although primarily seen in children, this rare type of liver cancer can also appear in adults and has a different cellular origin compared to classic HCC.

Causes of Hepatocellular carcinoma (HCC)

The primary causes of hepatocellular carcinoma are associated with chronic liver diseases and other risk factors:

1. Chronic Hepatitis B Infection

   • Persistent infection with hepatitis B virus (HBV) can lead to liver inflammation and cirrhosis, significantly increasing the risk of HCC.

2. Chronic Hepatitis C Infection

   • Similarly, hepatitis C virus (HCV) infection is a major risk factor for the development of HCC, often after years of chronic liver damage.

3. Cirrhosis

   • Regardless of the cause, cirrhosis (scarring of the liver) from various conditions, including alcoholic liver disease and nonalcoholic steatohepatitis (NASH), is a critical risk factor.

4. Aflatoxin Exposure

   • Aflatoxins, carcinogenic compounds produced by certain molds, can contribute to liver cancer risk, especially in areas with poor food storage practices.

5. Hemochromatosis

   • This genetic disorder leads to excessive iron accumulation in the liver, which can increase the risk of developing HCC.

6. Alpha-1 Antitrypsin Deficiency

   • A genetic condition that causes liver damage due to the accumulation of abnormal protein in the liver cells.

Risk Factors of Hepatocellular carcinoma (HCC)

Several factors increase the likelihood of developing HCC:

1. Chronic Liver Disease

   • Chronic conditions such as hepatitis B or C, and cirrhosis from any cause, are significant risk factors.

2. Age and Gender

   • HCC is more common in older adults and is generally more prevalent in men than women.

3. Family History

   • A family history of liver cancer or chronic liver disease may increase risk.

4. Alcohol Consumption

   • Chronic excessive alcohol use is a well-known risk factor for liver cirrhosis and subsequent HCC development.

5. Obesity and Diabetes

   • Conditions like obesity and type 2 diabetes contribute to liver damage and increase the risk of HCC.

6. Tobacco Use

   • Smoking has been linked to an increased risk of liver cancer, though the relationship is less direct compared to other risk factors.

7. Exposure to Aflatoxins

   • Living in areas where aflatoxin contamination is common can elevate the risk of HCC.

Symptoms of Hepatocellular carcinoma (HCC)

Preventions of Hepatocellular carcinoma (HCC)

Preventing HCC involves addressing risk factors and promoting liver health:

1. Vaccination

   • Vaccination against hepatitis B virus can prevent HBV infection and reduce the risk of HCC.

2. Regular Monitoring

   • Individuals with chronic hepatitis or cirrhosis should undergo regular liver function tests and imaging to detect early signs of cancer.

3. Avoiding Alcohol

   • Limiting or abstaining from alcohol can help prevent liver damage and reduce HCC risk.

4. Healthy Diet and Exercise

   • Maintaining a healthy weight and diet, and engaging in regular physical activity can mitigate risk factors such as obesity and diabetes.

5. Safe Practices

   • Avoiding exposure to aflatoxins and practicing safe sex to prevent hepatitis infections.

6. Managing Chronic Conditions

   • Proper management of chronic liver conditions and metabolic disorders can help prevent the progression to HCC.

Diagnosis of Hepatocellular carcinoma (HCC)

Diagnosing HCC involves several steps and tests:

1. Medical History and Physical Examination

   • Initial assessment of symptoms and risk factors through patient history and physical exam.

2. Blood Tests

   • Tests such as alpha-fetoprotein (AFP) levels can indicate the presence of liver cancer.

3. Imaging Studies

   • Techniques such as ultrasound, CT scan, and MRI are used to visualize the liver and detect tumors.

4. Biopsy

   • A liver biopsy may be performed to obtain a tissue sample for histopathological examination to confirm the diagnosis.

5. Genetic Testing

   • In some cases, genetic testing may be done to identify specific mutations associated with HCC.

Evaluation of Hepatocellular Carcinoma

Evaluating the extent and stage of HCC involves:

1. Staging

   • Determining the size, number, and location of tumors, as well as whether the cancer has spread to other parts of the body.

2. Liver Function Tests

   • Assessing liver function to determine how well the liver is working and how it might be affected by treatment.

3. Performance Status

   • Evaluating the patient's overall health and ability to tolerate treatment.

Treatment for Hepatocellular carcinoma (HCC)

Treatment for HCC varies based on the stage and overall health of the patient:

1. Surgical Resection

   • Removing the tumor and a portion of the liver if the cancer is localized and the liver function is adequate.

2. Liver Transplantation

   • Replacing the diseased liver with a healthy donor liver, suitable for patients with early-stage HCC and significant liver damage.

3. Ablation Therapy

   • Techniques such as radiofrequency ablation (RFA) or microwave ablation to destroy the tumor using heat.

4. Transarterial Chemoembolization (TACE)

   • Delivering chemotherapy directly to the liver tumor while blocking its blood supply.

5. Targeted Therapy

   • Using drugs that specifically target cancer cells or their environment to inhibit tumor growth.

6. Immunotherapy

   • Boosting the body’s immune system to recognize and attack cancer cells.

7. Systemic Chemotherapy

   • Administering drugs that circulate throughout the body to kill cancer cells.

8. Palliative Care

   • Providing supportive care to manage symptoms and improve the quality of life for patients with advanced HCC.

When to seek medical attention ?

Consult a healthcare professional if you experience symptoms suggestive of liver disease or cancer, such as:

• Persistent abdominal pain
• Unexplained weight loss
• Jaundice or dark urine
• Chronic fatigue or weakness
• History of chronic liver disease or hepatitis