Hepatocellular carcinoma (HCC) usually arises in patients with cirrhosis of the liver due to any cause.
A significant number of patients may be asymptomatic and are diagnosed following screening.
Patients at risk of HCC should receive surveillance with an ultrasound of the liver at 6-month intervals.
Treatment is guided by staging and prognosis. Treatment options include resection, transplantation, percutaneous ablation therapy, and chemo-embolisation.
Sorafenib and lenvatinib are the only targeted first-line agents for advanced-stage HCC. Regorafenib, nivolumab, pembrolizumab, and cabozantinib are prescribed second-line for patients who progress on sorafenib.
Ramucirumab is approved for advanced or unresectable HCC in patients who have an alpha fetoprotein level ≥400 micrograms/L (≥400 nanograms/mL) and have been previously treated with sorafenib.
Hepatocellular carcinoma (HCC), also known as hepatoma, is a primary cancer arising from hepatocytes in predominantly cirrhotic liver. However, some patients may not have cirrhosis before developing HCC, especially patients with chronic hepatitis B virus.
History and exam
- abdominal distention
- oesophageal or gastric variceal bleeding
- right upper quadrant pain
- early satiety
- weight loss
- leg oedema
- hepatic encephalopathy
- spider naevi
- palmar erythema
- periumbilical collateral veins
- fetor hepaticus
- paraneoplastic syndrome
- bone pain
- severe abdominal pain
- obstructive jaundice
- enlarged haemorrhoidal veins
- vascular bruit
- chronic hepatitis B (HBV) infection
- chronic hepatitis C (HCV) cirrhosis
- chronic heavy alcohol use
- family history of liver cancer
- Thorotrast radioactive contrast
- cigarette smoking
- alpha-1-antitrypsin deficiency
- porphyria cutanea tarda
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis
- androgenic steroids
- oral contraceptives
- male sex
Senior Consultant, Gastroenterology & Hepatology
Assistant Professor, Yong Loo Lin School of Medicine
National University of Singapore
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.
Department of Medicine
Division of Gastroenterology & Hepatology
National University Health System
QDN declares that he has no competing interests.
Dr Poh Seng Tan and Dr Qingyao Daniel Huang would like to gratefully acknowledge Dr Badar Muneer and Dr Smruti R. Mohanty, previous contributors to this topic.
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.
SN declares that he has no competing interests.
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
NS declares that he has no competing interests.
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