Hepatocellular carcinoma stands as the fifth most common cancer worldwide. This disease affects thousands of lives yearly. and ranks as the second leading cause of cancer death in men after lung cancer.
Doctors recognise hepatocellular carcinoma as the most common type of liver cancer. The disease represents more than 90% of primary liver tumours. People with cirrhosis face the highest risk, as this cancer develops in about 85% of diagnosed patients.
The disease's effects show clear patterns among different groups. Men's risk runs three times higher than women's. Most new cases—over 80%—show up in developing regions like Sub-Saharan Africa, South-East Asia, and China.
The mechanisms behind this disease tell an important story. Chronic viral hepatitis leads to the majority of cases worldwide. Hepatitis B causes roughly half of these cases, while hepatitis C accounts for a quarter. There's another reason to watch closely - non-alcoholic steatohepatitis has become the fastest-growing cause in the last two decades.
Knowledge about this condition helps you take the first step toward dealing with it. This article will walk you through symptoms, treatment options, and ways to live with liver cancer.
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer adults get. Unlike other cancers that spread to the liver, HCC starts right in the liver itself. The cancer begins in hepatocytes, which are the liver's main working cells.
The liver does so many important jobs in your body. It helps break down food, gets rid of waste, and makes vital substances your body can't do without. HCC can disrupt these normal functions when it develops.
This cancer makes up about 85% to 90% of all primary liver cancers. Most people receive their diagnosis after age 60.
HCC grows in two different ways:
- A single tumour gets bigger over time and might spread to other parts of the liver
- Multiple small cancer nodules appear throughout the liver (this happens more often in people with cirrhosis)
Early-stage HCC usually grows slowly. The cancer becomes aggressive and spreads faster as time goes on. Doctors can treat early cases with surgery or liver transplants, but they don't find most cases until the cancer has spread.
HCC rarely appears without warning. People with chronic liver disease, especially those who have cirrhosis (liver scarring), face the highest risk. Regular checkups become vital if you have any condition that affects your liver's health.
Causes and Risk Factors of Liver Cancer
Your chances of developing hepatocellular carcinoma can increase due to several factors. Knowing these risks helps you understand if you belong to a high-risk group.
Chronic viral infections rank highest among all risk factors. Hepatitis B and C viruses cause at least 80% of all liver cancers worldwide. People with chronic hepatitis B infection are 100 times more prone to develop liver cancer than those without it.
Cirrhosis is a vital part of how liver cancer develops. When healthy liver tissue turns into scar tissue, your cancer risk goes up dramatically. Most liver cancers show up in people who have cirrhosis, but chronic hepatitis B patients can sometimes develop cancer without it.
Your daily choices can make a big difference. Drinking too much alcohol damages your liver permanently and raises your cancer risk. Smoking also puts you at higher risk.
Your body weight affects your liver health a lot. Being overweight or obese accounts for many liver cancer cases. This often relates to non-alcoholic fatty liver disease, where fat builds up in your liver & can cause inflammation and damage.
Other risk factors include:
Diabetes raises liver cancer risk, especially when you have other risk factors
Exposure to aflatoxins from mouldy foods
Certain inherited liver diseases like hemochromatosis
Age—most diagnoses occur in people over 60, with highest rates among 85-89 year olds
Gender—men face a higher risk than women
Chemical exposure to substances like vinyl chloride increases your risk, particularly in industries using these materials.
People with HIV or AIDS face a higher risk because they can't fight hepatitis infections as well.
Your genes might play a part, too. Having close family members with liver cancer might mean you carry a slightly higher risk.
How Hepatocellular Carcinoma is Diagnosed with Staging
Early detection of hepatocellular carcinoma gives patients their best shot at successful treatment. Doctors rely on multiple diagnostic methods to accurately identify this condition.
Blood tests: A tumour marker called Alpha-fetoprotein (AFP) might show higher levels in people's blood who have liver cancer. Notwithstanding that, AFP doesn't appear in all liver cancers, which makes it unreliable as a standalone screening tool.
Imaging: Ultrasound usually serves as the first test and shows liver tumours with higher sensitivity in patients who have cirrhosis. Doctors might ask for additional tests:
CT scans - X-rays create detailed images that reveal the tumour's size, shape, and location
MRI - radio waves and magnets produce high-quality images instead of using X-rays
Many cirrhosis patients can get a definitive diagnosis without needing a biopsy during the diagnostic process. Hepatocellular carcinoma's signature appearance on imaging shows late arterial enhancement with "washout" during venous or delayed phases.
Biopsy:
A liver biopsy becomes essential only in these cases:
Unclear imaging results
Cancer develops in a non-cirrhotic liver
Patient enrollment in clinical trials
The TNM system helps determine cancer staging by looking at:
Tumour size and number
Lymph node involvement
Metastasis to distant organs
The Barcelona Clinic Liver Cancer (BCLC) staging system adds more value by looking at tumour characteristics, liver function, and patient performance status. Then, doctors can better predict outcomes and choose treatment options.
High-risk patients should get an ultrasound screening every six months, especially when they have cirrhosis or chronic hepatitis B infection.
Treatment Options for Hepatocellular Carcinoma
People diagnosed with hepatocellular carcinoma have multiple treatment options available. Doctors recommend specific approaches based on the tumour's size, how well your liver works, and your overall health.
Surgery gives the best chance for a cure in early-stage liver cancer. A liver resection removes the tumour and some healthy tissue around it. Another option is a liver transplant that replaces your liver with a donor's organ. The results from transplants look promising - over 50% of patients surviving at least 10 years.
Ablation treatments might be right for you if surgery isn't an option. These methods kill cancer cells by using:
Radiofrequency or microwave heat
Extreme cold (cryoablation)
Alcohol injection directly into tumours
Embolisation works well for larger tumours by delivering treatment straight to the cancer through blood vessels. You might get chemoembolisation, which combines cancer-fighting drugs with materials that block the tumour's blood supply. Some patients receive radioembolisation instead, where tiny radioactive beads lodge in the cancer's blood vessels.
Modern radiation therapy has improved by a lot. Stereotactic body radiation therapy (SBRT) sends precise radiation beams from different angles. This method shows great results.
Systemic treatments have grown rapidly, too. Most patients start with atezolizumab plus bevacizumab, which helps patients live longer compared to older treatments. The combination of tremelimumab plus durvalumab gives doctors another powerful first-line choice.
Targeted therapies like sorafenib, lenvatinib, regorafenib, and cabozantinib remain valuable options, especially after trying other treatments.
Your liver's health plays a crucial role in choosing the right treatment. Patients with severe liver damage might do better with supportive care that focuses on managing symptoms instead of aggressive treatments that could make things worse.
Living with Liver Cancer
Medical advancements have improved survival rates for people living with hepatocellular carcinoma, though challenges remain substantial. This common liver cancer develops in people who have existing liver damage, especially when you have cirrhosis. Early detection provides real hope, even though it ranks as the second leading cause of cancer death in men.
Risk factors play a crucial role in your health journey. Hepatitis B and C infections cause most cases worldwide. Your lifestyle choices like alcohol consumption and smoking can increase your risk considerably. Obesity and diabetes also raise your chances of developing this disease.
Blood tests and imaging studies usually start the diagnosis process, which often eliminates the need for invasive biopsies. The proper staging helps determine your ideal treatment path. Note that high-risk patients should undergo regular screening.
Treatment options have grown extensively over the last several years. Early-stage cases might benefit from surgical approaches like resection and transplantation that offer potential cures. Patients who can't undergo surgery have other options like ablation techniques, embolisation, radiation therapy, and newer drug combinations.
Regular medical care and understanding your risk factors remain your best defence against this disease. The statistics might seem overwhelming, but early detection combined with proper treatment can extend your life substantially and enhance its quality. You can protect your liver health by using this knowledge to spot warning signs early.
FAQs
How long can someone survive with hepatocellular carcinoma if left untreated?
Without treatment, patients with hepatocellular carcinoma typically survive for about 3 years. However, with appropriate treatment, 50-70% of patients can live for at least 5 years after diagnosis.
What changes occur in liver cells during hepatocellular carcinoma?
In hepatocellular carcinoma, liver cells (hepatocytes) undergo DNA changes, leading to abnormal growth. This cancer often develops in individuals with pre-existing liver conditions, such as cirrhosis caused by hepatitis B or C infections.
What are the possible risk factors for developing hepatocellular carcinoma?
The main risk factors include chronic hepatitis B and C infections, cirrhosis, heavy alcohol consumption, smoking, obesity, and diabetes. Certain inherited liver diseases and exposure to aflatoxins can also increase the risk.
How is hepatocellular carcinoma typically diagnosed?
Diagnosis usually involves blood tests, including alpha-fetoprotein levels, and imaging studies like ultrasound, CT scans, and MRI. In some cases, a liver biopsy may be necessary for confirmation, especially if imaging results are inconclusive.
What treatment options are available for hepatocellular carcinoma?
Treatment options vary and depend on the cancer stage and overall liver function. They may include surgical resection, liver transplantation, ablation techniques, embolisation, radiation therapy, and systemic treatments such as immunotherapy and targeted drugs.
