Hepatocellular carcinoma

Hepatocellular carcinoma (HCC or hepatoma)

Hepatocellular carcinoma accounts for most primary liver tumours. It occurs more often in men than women. It is usually seen in people ages 50-60yrs. 

In most cases, HCC develops in liver cirrhosis and is highly associated with hepatitis B and/or C infection.

Symptoms related to hepatomas occur only when they reach a significant size. Small hepatomas as usually diagnosed during investigations for other reasons or during screening scans in patients known to have cirrhosis. Large hepatomas may give pain and other symptoms such as fatigue, jaundice and ascites. Occasionally they may rupture causing severe intra abdominal bleeding.

Liver transplant is the treatment of choice as it has shown to give the longest survival. However only patients with small tumours (< 5 cm in diameter) and with less than 3 lesions in the liver are considered eligible. If transplant is not possible; surgery can be considered in patients with normal livers or when cirrhosis is still at an early stage. 

If surgery or transplant is not possible, other treatments such as Radiofrequency ablation (RFA) and transarterial chemoembolisation (TACE) can be offered. RFA for small lesions or a combination of RFA and TACE can achieve good results in some patients in terms of tumour ablation, control of tumoral growth or in some cases as a bridge toward surgery or transplant.

Traditionally chemotherapy and radiation treatments were not considered. However, new drugs such as Sorafenib tosylate have shown to be effective in blocking the tumour growth. Sorafenib is now approved for patients with advanced hepatocellular carcinoma.

Having explained the possible treatment options of this complex condition, every patient with HCC should be seen by a liver specialist for investigation and should be discussed in a liver multidisciplinary meeting with all involved clinicians from different specialities to decide the best management plan.