What Is Hepatocellular Carcinoma?

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Most people who develop this cancer have chronic liver disease. Treatments typically include surgery, chemotherapy, chemoembolization, and targeted therapy.

The American Cancer Society estimates that 41,210 people in the United States will be diagnosed with liver cancer in 2023. Many of these liver cancers will be hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. About 90% of liver cancer diagnoses are HCC.

This article will take a closer look at HCC, including its causes, symptoms, and how it’s diagnosed and treated.

HCC happens when liver cells have DNA changes that cause them to grow uncontrollably. The type of cell that’s affected by HCC is the hepatocyte, which is the main cell type in your liver, accounting for about 80% of the total cell population.

Over 90% of HCCs happen due to chronic liver disease, which is associated with prolonged inflammation and damage to the liver that can eventually lead to cirrhosis. As such, the main risk factors for HCC are:

In studies, the artificial intelligence (AI) technology used in some online health services for preliminary screening before connecting patients with a doctor actually outperformed real physicians in terms of reaching an accurate diagnosis, CNN AI technology correctly diagnosed conditions in 81% of patients, compared to a 72% average for accurate diagnoses among real physicians over a five-year period.

• Chronic viral hepatitis: Chronic infection with the hepatitis B or hepatitis C virus accounts for around 80% of HCC diagnoses globally. In the United States and Europe, hepatitis C is a more common cause of HCC. However, in other parts of the world, hepatitis B is more common.
• Alcohol: Excess alcohol consumption can damage the liver and is linked to 30% of HCC diagnoses in the United States. According to research, having three or more drinks per day was associated with a 16% increase in the risk of HCC.
• Nonalcoholic fatty liver disease (NAFLD):NAFLD is where too much fat has built up in your liver. It’s most commonly associated with conditions like obesity and diabetes. About 10% to 20% of HCCs in the United States are linked to NAFLD.

Other risk factors for HCC include:

• being older
• being assigned male at birth
• smoking
• being exposed to the fungal toxin aflatoxin B1
• having rare health conditions like:
  • primary biliary cholangitis
  • hereditary hemochromatosis
  • alpha1-antitrypsin deficiency
  • Wilson’s disease

  The symptoms of HCC can include:

  • pain, particularly in the upper righthand side of the abdomen or in the right shoulder blade
  • unintentional weight loss
  • reduced appetite
  • nausea and vomiting
  • yellowing of the skin and whites of the eyes (jaundice)
  • itchy skin
  • pale stool
  • dark urine
  • abdominal swelling
  • fatigue or weakness
  • fever
  • easy bruising or bleeding

  In order to diagnose HCC, your doctor will review your medical history and do a physical examination. They’ll then order several blood tests, such as:

  • liver function tests
  • blood clotting tests
  • complete blood count
  • metabolic panel
  • tests for hepatitis B or hepatitis C infection
  • alpha-fetoprotein (AFP) test

  If your doctor suspects HCC, they’ll likely also order imaging tests to check for the presence of tumors in your liver. This can be done using the following imaging techniques:

  Because HCC has characteristic features in imaging tests, liver biopsies aren’t typically needed to diagnose HCC. However, a biopsy may be ordered if an area has features atypical for HCC.

  Staging of hepatocellular carcinoma

  Following an HCC diagnosis, the cancer will then be staged. This is a measure of the extent of the cancer, including:

  • the size or number of tumors
  • whether the cancer has spread to nearby lymph nodes
  • whether the cancer has spread to more distant tissues like the bones or lungs

  HCC is also often associated with chronic liver disease. As such, it’s important to take into account not only the extent of the cancer, but the level of liver function as well.

  This can be done by using a staging system like the Barcelona Clinic Liver Cancer (BCLC) system. The BCLC system stages HCC based on:

  • the extent of the cancer
  • the level of liver function
  • overall health and fitness

  The treatment plan that’s recommended for HCC can depend on several factors, including:

  • the extent of the cancer
  • how well the liver is functioning
  • your age and overall health

  Some types of treatment for HCC focus on the removal or destruction of the cancer. This can include:

  • Surgery:Surgery for liver cancer involves removal of the affected part of the liver. Candidates for surgery typically have good liver function and smaller tumors that don’t affect nearby blood vessels.
  • Liver transplant: If your liver isn’t very healthy, but your HCC is still in an earlier stage, a liver transplant may be an option.
  • Ablation: Ablation destroys cancer cells with heat or cold. It may be used:
    • to treat HCC that’s in its earliest stage
    • to help manage HCC while you wait for a liver transplant
    • to treat HCC when you’re not healthy enough for surgery or a liver transplant

    In some situations, HCC cannot be surgically removed. This may be because there is a lot of cancer in the liver or due to the fact that the cancer has spread further. You may also not be healthy enough for surgery or a transplant.

    In these situations, one or more other treatments may be used, such as:

    • Chemotherapy: Chemotherapy uses drugs that affect the growth and division of rapidly-dividing cells like cancer cells.
    • Chemoembolization: This process delivers chemotherapy into an artery of the liver and then blocks it to prevent blood flow to the tumor.
    • Radiation therapy: This therapy uses high-energy radiation to kill cancer cells.
    • Targeted therapy: This therapy uses drugs like bevacizumab (Avastin) or sorafenib (Nexavar) to target specific aspects of HCC.
    • Immunotherapy: Immunotherapy uses drugs like atezolizumab (Tecentriq) or pembrolizumab (Keytruda) to help your immune system respond to HCC.

    What complications can hepatocellular carcinoma lead to?

    The complications of HCC can include:

    • ascites
    • portal hypertension
    • a blocked bile duct
    • a blood clot that blocks the portal vein
    • liver abscesses
    • variceal bleeding, which happens due to portal hypertension and is the rupture of enlarged veins in the digestive tract
    • hepatic encephalopathy, a decline in brain function due to toxins in the blood

    What is the survival rate for hepatocellular carcinoma?

    According to the SEER database of the National Cancer Institute , the 5-year relative survival rate for liver cancer, of which HCC is the most common type, is:

    • 36.1% when the cancer is localized to the liver
    • 12.8% when the cancer has spread to nearby tissues or lymph nodes
    • 3.1% when the cancer has spread to distant organs and tissues
    • 20.8% overall

    Is hepatocellular carcinoma an aggressive cancer?

    HCC can often be aggressive. This means that it grows and spreads quickly.

    Genetic analysis can be used to divide HCC into two classes: proliferative and non-proliferative. Proliferative HCCs are more aggressive than non-proliferative HCCs and tend to have a poorer outlook.

    HCC is the most common type of liver cancer. It’s often associated with chronic liver disease that can be caused by viral hepatitis, excess alcohol consumption, or NAFLD.

    Several treatments may be used for HCC, including surgery, chemotherapy, chemoembolization, and targeted therapy. However, the outlook for HCC is typically poor.

    Many risk factors for HCC are related to lifestyle. You can reduce your risk of HCC by taking steps to avoid contracting hepatitis B or C, drinking alcohol in moderation, and managing your weight, if necessary.

    Last medically reviewed on April 12, 2023