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Liver Cancer: Hepatocellular Carcinoma (HCC)

Overview

Hepatocellular carcinoma (HCC), commonly referred to as primary liver cancer, originates in the liver. It most often develops in individuals with chronic liver disease or cirrhosis.

Cirrhosis develops within a liver when it gets damaged by liver disease – hepatitis (B, C); alcohol, fatty liver disease (NAFLD), autoimmune liver disease and others. Cirrhosis is irreversible and over time predisposes to the development of liver cancer (among other complications).

  • Hepatocellular Carcinoma (HCC): The most common type, arising from hepatocytes, the primary liver cells.
  • Intrahepatic Cholangiocarcinoma: Cancer originating in the bile ducts within the liver.
  • Fibrolamellar Carcinoma: A rare subtype of HCC seen in younger individuals without underlying liver disease.

Liver cancer typically results from genetic mutations in liver cells, causing uncontrolled growth and tumour formation.

  • Chronic liver disease:
    • Cirrhosis caused by hepatitis B or C infection.
    • Non-alcoholic fatty liver disease (NAFLD).
    • Alcohol-induced liver damage.
  • Lifestyle factors:
    • Heavy alcohol consumption.
    • Obesity and poor dietary habits.
  • Environmental and genetic factors:
    • Exposure to aflatoxins (contaminants in food).
    • Genetic predisposition to liver diseases.

Liver cancer often remains asymptomatic in its early stages. Common symptoms include:

  • Persistent abdominal pain or discomfort.
  • Loss of appetite and significant weight loss.
  • Fatigue and weakness.
  • A feeling of heaviness in the upper abdomen.
  • Jaundice (yellowing of skin and eyes).
  • Swelling in the abdomen due to fluid accumulation (ascites).

  • Ultrasound: Often detects liver cancer incidentally during routine check-ups or screening in high-risk individuals.
  • Alpha-Fetoprotein (AFP) Test: A tumour marker elevated in many cases of HCC.
  • CT and MRI Scans: Provide detailed images to assess tumour size, location, and spread.
  • PET-CT Scan: Helps determine whether cancer has metastasised to other parts of the body.
  • Liver Function Tests: Evaluate the liver’s overall health.
  • Biopsy: Confirms the diagnosis by analysing tissue samples.

Treatment for liver cancer depends on tumour size, extent of disease, liver function, and overall health. Options include:

  • Surgery
    • Hepatectomy: Removal of the cancerous portion of the liver. Suitable for patients with localised tumours and preserved liver function.
    • Can be performed using open surgery, laparoscopy, or robotic-assisted techniques.
  • Liver Transplantation
    • Recommended for patients with cirrhosis and localised liver cancer.
    • Involves replacing the diseased liver with a healthy one from a deceased or living donor.
  • Ablative Therapies
    • Radiofrequency Ablation (RFA) or Microwave Ablation (MWA): Destroy tumours using heat generated by electrical currents or microwaves.
  • Transarterial Therapies
    • Transarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumour via blood vessels, cutting off its blood supply.
    • Transarterial Radioembolization (TARE): Uses radioactive beads to target and destroy the tumour.
  • Systemic Treatments
    • Chemotherapy: Oral or intravenous medications to control advanced cases.
    • Targeted Therapy: Medications like sorafenib that block specific cancer cell pathways.
    • Immunotherapy: Drugs that enhance the immune system's ability to fight cancer cells.

  • Avoid excessive alcohol consumption and maintain a healthy weight.
  • Get vaccinated against hepatitis B and seek treatment for hepatitis C if diagnosed.
  • Regular screening for high-risk individuals, particularly those with cirrhosis.
  • Consume a balanced diet and avoid exposure to aflatoxins.
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