Hepatocellular carcinoma
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- history of cirrhosis
- history of chronic hepatitis B (HBV) or C (HCV)
- history of chronic heavy alcohol use
- history of diabetes or obesity
- family history of liver cancer
- older age
- hepatomegaly
Otros factores de diagnóstico
- abdominal distension
- esophageal or gastric variceal bleeding
- right upper quadrant abdominal pain
- early satiety
- weight loss
- lower extremity edema
- hepatic encephalopathy
- cachexia
- jaundice
- splenomegaly
- asterixis
- spider nevi
- palmar erythema
- periumbilical collateral veins
- fetor hepaticus
- diarrhea
- paraneoplastic syndrome
- bone pain
- severe abdominal pain
- obstructive jaundice
- enlarged hemorrhoidal veins
- vascular bruit
Factores de riesgo
- cirrhosis
- chronic hepatitis B (HBV) infection
- chronic hepatitis C (HCV) infection
- chronic heavy alcohol use
- diabetes
- obesity
- family history of liver cancer
- aflatoxin exposure
- thorium dioxide radioactive contrast exposure
- hemochromatosis
- cigarette smoking
- alpha-1-antitrypsin deficiency
- porphyria cutanea tarda
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- use of androgenic steroids
- use of oral contraceptives
- male sex
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- ultrasound of liver
- CBC
- basic metabolic panel
- liver function tests
- prothrombin time/INR
- viral hepatitis panel
- alpha fetoprotein (AFP)
Pruebas diagnósticas que deben considerarse
- contrast CT scan of abdomen
- contrast MRI of abdomen
- liver biopsy
- CT scan of chest
- bone scan
Algoritmo de tratamiento
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): nonhepatic resection candidate
BCLC stage B: intermediate disease
BCLC stage C: advanced disease
BCLC stage D: end-stage disease
recurrence
Colaboradores
Autores
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
Divulgaciones
DYD has received grant support from Roche Diagnostic International Ltd., Fujifilm Medical Systems, and DELFI Diagnostics LLC.
Ngoc Thai Truong, MD, MS
Research Assistant
Vietnam Viral Hepatitis Alliance
Reston
VA
Divulgaciones
NTT declares that he has no competing interests.
Agradecimientos
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.
Divulgaciones
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.
Revisores por pares
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Divulgaciones
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
Divulgaciones
NS declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hepatocellular carcinoma [internet publication].Texto completo
Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023 Dec 1;78(6):1922-65.Texto completo
Vogel A, Chan SL, Dawson LA, et al. Hepatocellular carcinoma: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2025 May;36(5):491-506.Texto completo
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatocellular carcinoma. J Hepatol. 2025 Feb;82(2):315-74.Texto completo Resumen
Su GL, Altayar O, O'Shea R, et al. AGA clinical practice guideline on systemic therapy for hepatocellular carcinoma. Gastroenterology. 2022 Mar;162(3):920-34.Texto completo Resumen
Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline update. J Clin Oncol. 2024 May 20;42(15):1830-50.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Cholangiocarcinoma
- Hepatic adenoma
- Hemangioma of liver
Más DiferencialesGuías de práctica clínica
- NCCN clinical practice guidelines in oncology: management of immune checkpoint inhibitor-related toxicities
- Critical update: AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma
Más Guías de práctica clínicaCalculadoras
Child Pugh classification for severity of liver disease
MELD Score for End-Stage Liver Disease (NOT appropriate for patients under the age of 12)
Más Calculadoras
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