Hepatocellular carcinoma (HCC) is a type of cancer that starts as a growth of cells in the liver. The liver is an organ that sits just under the rib cage on the right side of the belly. It helps the body digest food and get rid of waste products, among other tasks.
Hepatocellular carcinoma is the most common type of liver cancer. It starts in liver cells called hepatocytes. Hepatocellular carcinoma happens most often in people with chronic liver conditions, such as cirrhosis caused by hepatitis B or hepatitis C infection.
What is Hepatocellular Carcinoma?
Hepatocellular carcinoma develops when liver disease or some other changes mutate the cells in the liver. The changes cause the cells to make many more diseased cells that form a growth called a tumour. The tumour can damage healthy liver tissue and grow into nearby blood vessels. The cells can break away and spread to other parts of the body.
Hepatocellular carcinoma is one of the most serious cancers. It may not cause symptoms right away, which means it can grow without being detected. It also tends to happen in people with serious liver disease, which may make treatment more difficult.
Symptoms
Hepatocellular carcinoma doesn't cause early symptoms.
If signs and symptoms of hepatocellular carcinoma develop, it usually means the disease is advanced. Symptoms may include:
Losing weight without trying.
Loss of appetite.
A growth in the abdomen.
Yellowing of the skin and the whites of the eyes. This is called jaundice. It happens when a substance called bilirubin builds up in the blood.
Causes
The main causes of hepatocellular carcinoma are liver scarring, called cirrhosis, and infection with the hepatitis B virus or the hepatitis C virus. But not everyone with this type of cancer has a serious liver condition. It's not clear what causes hepatocellular carcinoma in people who don't have liver disease.
Hepatocellular carcinoma develops when cells in the liver called hepatocytes undergo changes in their DNA. These changes tell the cancer cells to grow and multiply quickly.
The cancer cells form a mass called a tumour. The tumour can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.
Risk factors
Risk factors for hepatocellular carcinoma include:
Hepatocellular carcinoma is more common in older adults.
Ongoing or previous infection with the hepatitis B virus or hepatitis C virus increases the risk of hepatocellular carcinoma.
Certain inherited liver diseases that can run in families may increase the risk of hepatocellular carcinoma. Examples include hemochromatosis and Wilson's disease.
People with metabolic dysfunction-associated steatotic liver disease are at an increased risk of hepatocellular carcinoma.
People with diabetes have a greater risk of hepatocellular carcinoma than those who don't have diabetes.
People with obesity have a higher risk of cirrhosis and excess fat in the liver. These conditions increase the risk of hepatocellular carcinoma.
Exposure to aflatoxins increases the risk of hepatocellular carcinoma. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase the risk of hepatocellular carcinoma.
People who smoke cigarettes are at an increased risk of hepatocellular carcinoma.
Complications
Hepatocellular carcinoma can spread to other parts of the body. When it spreads, it most often goes to the:
Lungs.
Lymph nodes in the abdomen.
Bones.
Adrenal glands.
Brain.
Prevention
Reduce your risk of cirrhosis:
Cirrhosis is scarring of the liver, and it increases the risk of hepatocellular carcinoma. You can reduce your risk of cirrhosis if you:
Drink alcohol in moderation
Maintain a healthy weight
Get vaccinated against hepatitis B:
Infection with the hepatitis B virus increases the risk of hepatocellular carcinoma. You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, children, adults and older adults.
Take measures to prevent hepatitis C:
Infection with the hepatitis C virus increases the risk of hepatocellular carcinoma. No vaccine for hepatitis C exists, but you can reduce your risk of infection.
Don't engage in unprotected sex unless you're certain your partner isn't infected with hepatitis B, hepatitis C or any other sexually transmitted infection.
Don't use intravenous drugs, but if you do, use a sterile needle. Contaminated needles are a common cause of hepatitis C infection.
Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilised can spread the hepatitis C virus.
Ask about liver cancer screening:
People with conditions that increase the risk of liver cancer might consider screening. People with an increased risk include those who have:
Hepatitis B infection.
Hepatitis C infection.
Liver cirrhosis.
Talk about the pros and cons of screening with your doctor. Together, you can decide whether screening is right for you based on your risk. Hepatocellular carcinoma screening typically involves a blood test and an abdominal ultrasound every six months.
Diagnosis
To diagnose hepatocellular carcinoma, your doctor might do a physical exam and ask questions about your health history. Other tests and procedures are:
Imaging tests
Imaging tests make pictures of the body. They can show the location and size of a hepatocellular carcinoma. Tests might include:
Ultrasound.
Computerised tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Positron emission tomography (PET) scan
Liver function tests
Blood tests can give your healthcare team clues about what's causing your symptoms. These might include tests that measure how well the liver is working, such as:
Alanine transaminase (ALT) test
Aspartate transaminase (AST) test
Alkaline phosphatase (ALP) test
Albumin test
Bilirubin test
Prothrombin time (PT) test
Tumour marker test
Tumour marker tests look for chemicals made by the cancer cells. The alpha-fetoprotein (AFP) blood test is a tumour marker test used for hepatocellular carcinoma.
Healthcare teams may use AFP test results along with other results to decide whether a growth in the liver might be cancer.
Biopsy
A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is tested in a laboratory to determine if it contains cancer cells.
Not everyone needs a biopsy to diagnose hepatocellular carcinoma. Sometimes healthcare teams make the diagnosis using the results of other tests.
Treatment
Treatment for hepatocellular carcinoma depends on the location and the extent of the cancer. Treatment also may depend on the condition of the liver. Treatment options include:
Surgery
Treatment for hepatocellular carcinoma may start with surgery to remove part of the liver including the cancer or the whole liver with a transplant. Surgery options include:
Surgery to remove the cancer: A partial hepatectomy is used for people whose cancer is in one part of the liver. This surgery removes the cancer and some healthy tissue around it.
Liver transplant surgery: Sometimes, surgery to remove the cancer is combined with a liver transplant. A surgeon removes the cancer and all of the liver. Then the surgeon puts a healthy liver from a donor into the body. A liver transplant may be an option in otherwise healthy people whose cancer hasn't spread beyond the liver. Other treatments may be used to treat the cancer while waiting for a transplant.
Other liver procedures
Other procedures on the liver can help treat hepatocellular carcinoma. These treatments may be used in people who can't have surgery to remove the cancer. These other liver procedures for hepatocellular carcinoma include:
Radiofrequency ablation: Radiofrequency ablation uses electric current and heat to destroy the cancer cells.
Cryoablation: Cryoablation uses cold to kill the cancer cells.
Chemoembolisation: Chemoembolisation gives chemotherapy medicines directly to the cancer.
Radioembolisation: Radioembolisation uses tiny beads that hold radiation. The healthcare team puts the beads into a blood vessel that goes to the liver. The beads give off radiation directly to the cancer.
Radiation therapy: Radiation therapy targets the cancer in the liver.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells.
Immunotherapy may be used after surgery to kill any remaining cancer cells. For those with advanced hepatocellular carcinoma that can't be removed with surgery, immunotherapy may be an option.
Targeted therapy
Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
Targeted therapy may be used after surgery to kill any remaining cancer cells. For those with advanced hepatocellular carcinoma that can't be removed with surgery, targeted therapy may be an option.
Conclusion
Hepatocellular carcinoma represents one of the most serious challenges in liver health, yet early detection and timely intervention can dramatically alter outcomes. The journey from risk factors like hepatitis B, hepatitis C, and fatty liver disease to advanced cancer stages underscores the critical importance of regular health screenings, particularly for individuals with known liver conditions. Modern treatment approaches—from surgical resection to liver transplantation and targeted therapies—offer hope even in complex cases, but their success hinges on catching the disease before it progresses.
FAQs
Does hepatocellular carcinoma always happen because of cirrhosis?
Not every time. Cirrhosis from things like hepatitis or heavy drinking is a big risk, but HCC might also show up in people without cirrhosis. Other causes are:
Long-term infections like hepatitis B and hepatitis C
Excessive alcohol consumption
Is it possible to spot hepatocellular carcinoma?
Yes, it is. Doing regular screenings using ultrasounds and blood tests such as AFP in people at high risk can help find HCC. Treating it sooner works better.
