Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- older age
- hepatomegaly
Other diagnostic factors
- abdominal distension
- oesophageal or gastric variceal bleeding
- right upper quadrant abdominal pain
- early satiety
- weight loss
- lower extremity oedema
- hepatic encephalopathy
- cachexia
- jaundice
- splenomegaly
- asterixis
- spider naevi
- palmar erythema
- periumbilical collateral veins
- fetor hepaticus
- diarrhoea
- paraneoplastic syndrome
- bone pain
- severe abdominal pain
- obstructive jaundice
- enlarged haemorrhoidal veins
- vascular bruit
Risk factors
- cirrhosis
- chronic hepatitis B (HBV) infection
- chronic hepatitis C (HCV) infection
- chronic heavy alcohol use
- diabetes
- obesity
- family history of liver cancer
- aflatoxin
- thorium dioxide radioactive contrast
- haemochromatosis
- cigarette smoking
- alpha-1-antitrypsin deficiency
- porphyria cutanea tarda
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- androgenic steroids
- oral contraceptives
- male sex
Diagnostic investigations
1st investigations to order
- full blood count
- basic metabolic panel
- liver function tests
- prothrombin time/INR
- viral hepatitis panel
- alpha fetoprotein (AFP)
- ultrasound of liver
Investigations to consider
- contrast CT scan of abdomen
- contrast MRI of abdomen
- liver biopsy
- computed tomography scan of chest
- bone scan
Treatment algorithm
Barcelona Clinic Liver Cancer (BCLC) stage 0-A (very early 0 or early disease A): possible surgical candidate (good liver function)
BCLC stage 0-A (very early 0 or early disease A): non-hepatic resection candidate
BCLC stage B: intermediate disease
BCLC stage C: advanced disease
BCLC stage D: end-stage disease
recurrence
Contributors
Authors
Doan Y Dao, MD
Assistant Professor of Medicine
Director, Center of Excellence for Liver Disease in Vietnam
Johns Hopkins School of Medicine
Department of Medicine
Division of GI & Hepatology
Baltimore
MD
Disclosures
DYD receives grants from Roche, Fujifilm Medical System, and DELFI Diagnostics; serves as Guest Director of Hepatology for Tech University; and is a member of the Data and Safety Monitoring Board of IQVIA.
Ngoc-Thai Truong, MD, MS
Research Assistant
Vietnam Viral Hepatitis Alliance
Reston
VA
Disclosures
NTT declares that he has no competing interests.
Acknowledgements
Dr Doan Y Dao and Dr Ngoc-Thai Truong would like to gratefully acknowledge Dr Qingyao Daniel Huang, Dr Margaret Li Peng Teng, Dr Poh Seng Tan, Dr Badar Muneer, and Dr Smruti R. Mohanty, previous contributors to this topic.
Disclosures
QDH declares that he has no competing interests. MLPT declares that she has no competing interests. PST has received sponsorship/honorarium from Bayer (South East Asia) Pte Ltd and Sirtex for attending conferences, delivering lectures, and participating in advisory board meetings. BM declares that he has no competing interests. SRM serves as a speaker for Bristol-Myers Squibb regarding the use of entecavir for the treatment of chronic hepatitis B.
Peer reviewers
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Disclosures
NS declares that he has no competing interests.
Differentials
- Cholangiocarcinoma
- Hepatic adenoma
- Haemangioma of liver
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