Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Early detection through screening is crucial for improving outcomes.
What is hepatocellular carcinoma?
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. "Primary" means it starts in the liver, as opposed to cancer that spreads to the liver from another part of the body, like metastatic liver cancer. HCC originates in the hepatocytes, which are the main type of liver cell. These cells are responsible for many of the liver's vital functions, such as filtering toxins from the blood, producing bile, and storing energy. HCC is a significant health problem worldwide. It's a leading cause of cancer-related deaths.
HCC most often develops in people who already have some form of chronic liver disease. The most common underlying conditions are:
- Cirrhosis: Scarring of the liver, often caused by:
- Chronic hepatitis B or C infection
- Excessive alcohol consumption
- Metabolic associated liver disease (MALD) and metabolic associated fatty liver disease (MAFLD)
- Other chronic liver conditions, although this is less common
AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence
At the AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence, we provide comprehensive care for patients diagnosed with hepatopancreatobiliary (HPB) cancers such as hepatocellular carcinoma (HCC) and biliary tumors, including cholangiocarcinoma and gallbladder cancer. The team, which includes oncologists, hepatologists, surgeons, pathologists, and radiologists, deeply understands the complexities and challenges of these liver, bile duct, and gallbladder cancers. Using a multidisciplinary approach, the team works together to develop personalized treatment plans that aim to achieve the best possible outcomes for each patient.
Why choose AHN for liver cancer care?
We offer one of the most robust liver cancer treatment programs in the region. Our skilled team treats liver cancer that has originated in the liver, as well as cancer that has spread to the liver from another part of the body. We meet regularly to discuss your treatment plan and make recommendations for the next steps in your care. You can expect treatment that is:
- Personalized: Our team works together to create a treatment plan specifically targeted to your needs.
- Patient-centric: Our specialists help coordinate appointments, answer questions about symptoms and treatment options, and provide logistical support when it comes to travel and planning. We help lift the burden of logistics so you can focus on getting better. Our psychiatrists and social workers are available for transplant patients, to keep your mind and body feeling its best. And our support services, like palliative care and support groups, provide care for the whole person.
- Collaborative: Your treatment team will work together every step of the way to identify the exact right treatment for you, whether it’s surgery, medical oncology, or radiation therapy. The high level of collaboration leads to better results for patients.
- Pioneering: We operate one of the most robust liver transplant programs in the country. AHN also offer groundbreaking therapies like stereotactic body radiation therapy (SBRT) and access to clinical trials, as well as liver surgery and resections, so you have access to the latest treatments and the best chances of getting well.
Hepatocellular carcinoma symptoms and signs
In the early stages, hepatocellular carcinoma often doesn't cause any noticeable symptoms. This is one reason why regular screening is important for people at high risk. People with chronic hepatitis B or C, cirrhosis, heavy alcohol consumption, nonalcoholic fatty liver disease (NAFLD), or a family history of liver cancer are at higher risk and may benefit from regular screening with ultrasound and blood tests (alpha-fetoprotein or AFP).
As the cancer grows, the following symptoms may develop:
- Abdominal pain or discomfort: This is often felt in the upper right abdomen, where the liver is located. The pain may be dull, aching, or sharp.
- Abdominal swelling (ascites): Fluid can build up in the abdomen, causing it to swell. This can also lead to a feeling of fullness or bloating.
- Lump in the abdomen: A hard lump may be felt under the ribs on the right side of the abdomen.
- Jaundice: Yellowing of the skin and whites of the eyes. This is caused by a buildup of bilirubin in the blood, which the liver normally processes.
- Unexplained weight loss: If you are losing weight without trying.
- Loss of appetite: Feeling less hungry than usual or feeling full after eating only a small amount.
- Nausea and vomiting: Feeling sick to your stomach and throwing up.
- Weakness and fatigue: Feeling tired and weak, even after resting.
- Enlarged liver (hepatomegaly): The liver may become enlarged and can be felt during a physical exam.
- Enlarged spleen (splenomegaly): The spleen may also become enlarged.
- Itching (pruritus): Generalized itching all over the body.
- Dark urine: Urine may appear darker than usual.
- Light-colored or clay-colored stool: These specific changes could be due to liver damage.
- Unexplained fever: If high temperatures are not accompanied by general reasons.
Many people who develop HCC already have underlying liver disease, such as cirrhosis or hepatitis. These conditions can cause their own set of symptoms, which may overlap with the symptoms of HCC. These symptoms may include:
- Easy bruising or bleeding: The liver produces proteins that help with blood clotting. When the liver is damaged, it may not produce enough of these proteins, leading to easy bruising or bleeding.
- Mental confusion or personality changes (hepatic encephalopathy): A buildup of toxins in the blood can affect brain function.
- Esophageal varices: Enlarged veins in the esophagus that can bleed.
Causes and risk factors
Hepatocellular carcinoma (HCC) is a common liver cancer that can be caused by preexisting conditions and other diseases, and there are certain population groups that can be more at risk for developing HCC. The cause of HCC can include:
- Chronic viral hepatitis: This is the leading cause of HCC worldwide.
- Hepatitis B virus (HBV): Chronic HBV infection is a major risk factor, even in the absence of cirrhosis.
- Hepatitis C virus (HCV): Chronic HCV infection is another significant cause, often leading to cirrhosis and then HCC.
- Cirrhosis: This is a condition of irreversible scarring of the liver. It's important to understand that not all people with cirrhosis will develop HCC, but it significantly increases the risk. Common causes of cirrhosis include:
- Alcohol-Related Liver Disease: Excessive alcohol consumption over many years can lead to cirrhosis and HCC.
- Metabolic associated liver disease (MALD) and metabolic associated fatty liver disease (MAFLD): These conditions are linked to obesity, diabetes, and metabolic syndrome. Non-alcoholic steatohepatitis (NASH) is a more severe form of non-alcoholic fatty liver disease (NAFLD) that can lead to cirrhosis and HCC.
- Aflatoxins: These are toxins produced by certain molds that can contaminate food crops like peanuts, corn, and rice. Aflatoxin exposure is a significant risk factor in some parts of the world.
The risk factors for developing HCC can include:
- Gender: HCC is more common in men than in women.
- Age: The risk of HCC increases with age.
- Certain genetic/metabolic diseases:
- Hereditary hemochromatosis: This condition causes the body to absorb too much iron, which can damage the liver.
- Wilson's disease: This is a rare genetic disorder that causes copper to accumulate in the liver.
- Alpha-1 antitrypsin deficiency: This genetic condition can lead to liver and lung disease.
- Obesity and type 2 diabetes: These conditions are strongly linked to NASH and NAFLD, which, as mentioned above, can increase HCC risk.
- Smoking: Smoking is associated with an increased risk of HCC.
- Anabolic steroid use: Long-term use of anabolic steroids has been linked to HCC.
Hepatocellular carcinoma screening and diagnosis
Early detection and treatment can improve liver cancer survival rates. The exact frequency and duration may vary based on individual risk factors and local guidelines.
- Ultrasound: This is the primary screening tool. It's noninvasive and can detect liver tumors. Ultrasound is usually performed every six months.
- Alpha-fetoprotein (AFP) blood test: AFP is a protein produced by the liver and some HCC cells. Elevated AFP levels can be a sign of HCC, but it's not always reliable as a stand-alone test. It's often used in conjunction with ultrasound. Note that AFP can also be elevated in other conditions.
- Combined approach: The American Association for the Study of Liver Diseases (AASLD) and other guidelines recommend using both ultrasound and AFP for screening. However, the effectiveness of AFP is debated, and some centers rely primarily on ultrasound.
- Newer biomarkers: Research is ongoing to identify more sensitive and specific biomarkers for HCC detection. Some newer biomarkers are being used in clinical practice in certain settings.
Your doctor will request additional diagnostic tests when a screening test is abnormal (e.g., a new liver nodule is detected on ultrasound) or a patient presents with symptoms suggestive of HCC (e.g., abdominal pain, jaundice, weight loss.)
Imaging
Imaging plays a crucial role in both diagnosing and staging HCC. AHN uses advanced technologies that provide critical information to your care team that will help them plan your personalized treatment. Imaging treatment that may be used includes:
- Contrast-enhanced CT scan (Computed Tomography): Uses X-rays to create detailed cross-sectional images of the liver. Contrast dye is injected to highlight blood vessels and tumors. Specific HCC protocols are used to assess for arterial hyperenhancement and washout (characteristic features of HCC).
- Contrast-enhanced MRI (Magnetic Resonance Imaging): Uses magnetic fields and radio waves to create detailed images of the liver. Liver-specific contrast agents may be used to improve detection of small tumors. Often more sensitive than CT for detecting small HCCs. Also uses specific HCC protocols to assess for arterial hyperenhancement and washout.
- Contrast-enhanced ultrasound (CEUS): Uses ultrasound with a contrast agent to visualize liver nodules. Can be used to characterize nodules in real time. May be an alternative to CT or MRI in certain situations.
- Angiography: An X-ray of blood vessels, used in some cases to further evaluate the blood supply to the tumor.
Liver biopsy
A liver biopsy is a diagnostic procedure where a small sample of liver tissue is taken for examination under a microscope. This procedure may be done percutaneously (through the skin) with image guidance (ultrasound or CT) or laparoscopically (using a small incision and a camera). The pathologist examines the tissue sample to confirm the presence of cancer cells, determine the grade of the cancer (how aggressive it is), and look for other features that can help guide treatment.
Blood tests
Blood tests can measure levels of substances that indicate how well the liver is functioning. If the liver is damaged or diseased (like with cancer), it may not process these substances correctly, leading to abnormal levels. Some blood tests look for specific substances (proteins or other molecules) that are produced by cancer cells. These substances, called tumor markers, can be elevated in people with cancer. Your doctor may order the following blood tests:
- Liver function tests (LFTs): To assess liver function and damage.
- Alpha-fetoprotein (AFP): To monitor tumor activity (though not always reliable for diagnosis).
- Complete blood count (CBC): To assess overall health and detect any blood disorders.
- Viral hepatitis tests: To check for hepatitis B or C infection.
- Other tumor markers: May be measured in some cases.
Types and stages of hepatocellular carcinoma
While "hepatocellular carcinoma" is the main type of liver cancer, there are some less common subtypes and growth patterns that pathologists may identify under the microscope. These subtypes may have slightly different characteristics and prognoses:
- Fibrolamellar HCC: A rare subtype that typically occurs in younger adults (often under 40) who do not have underlying cirrhosis or other risk factors for HCC. Often has a better prognosis than classic HCC. May be more amenable to surgical resection.
- Clear cell HCC: A subtype in which the cancer cells have a clear or pale appearance under the microscope.
- Sarcomatoid HCC: A rare and aggressive subtype in which the cancer cells have a spindle-shaped or sarcomatous appearance. Often associated with a poorer prognosis.
- Mixed HCC: Some tumors may have a combination of different HCC subtypes.
Doctors use different systems to stage HCC. The most common one is called the TNM system, which looks at three main things:
- T (Tumor): This describes the size and number of tumors in your liver, and whether they have grown into nearby blood vessels.
- N (Nodes): This tells whether the cancer has spread to nearby lymph nodes (small, bean-shaped organs that help fight infection).
- M (Metastasis): This indicates whether the cancer has spread (metastasized) to other parts of your body, like your lungs, bones, or other organs.
The TNM information is then combined to assign an overall stage to the cancer, ranging from 0 to IV (4). In general:
- Stage 0 (Very Early): The cancer is very small and hasn't spread. This is often found during routine screening.
- Stage I (Early): The cancer is still small and hasn't spread to lymph nodes or other parts of the body.
- Stage II (Intermediate): The cancer is larger, or there may be multiple tumors, but it still hasn't spread to lymph nodes or distant sites.
- Stage III (Advanced): The cancer has grown into major blood vessels of the liver or has spread to nearby lymph nodes. This stage has different subcategories.
- Stage IV (Advanced): The cancer has spread to distant parts of the body. This is the most advanced stage.
Hepatocellular carcinoma treatment
The specific treatment plan for each patient will depend on the stage of the cancer and the patient's liver function, overall health, and preferences. It's crucial to emphasize that treatment decisions are made by a multidisciplinary team of specialists.
Treating early-stage hepatocellular carcinoma
For patients with early-stage HCC, we offer curative treatments such as:
- Surgical resection: Our surgeons perform minimally-invasive and robotic surgery whenever possible to facilitate a speedy recovery.
- Liver transplantation: A surgical procedure in which a diseased or damaged liver is replaced with a healthy liver from another person (the donor). It is a life-saving treatment option for people with severe liver disease that is no longer responding to other treatments.
- Ablative therapies: Designed to remove or destroy the tumor while preserving as much healthy tissue as possible.
- Percutaneous ablation of liver tumors: Using microwave (heating) and cryo (cooling) ablation technology using a small needle placed within the tumor using ultrasound or CT-scan guidance to destroy tumors without the need for invasive surgery.
- Percutaneous pulsed electric field ablation: Using electrical energy, we safely destroy tumor cells near critical structures like blood vessels and other organs while also unlocking the tumor to recognition by the immune system in order to train the body’s own immunity to better fight cancer elsewhere in the body.
Treating advanced HCC
For those with more advanced HCC, where surgery may not be the first option, we offer innovative neoadjuvant treatments to shrink tumors and increase the likelihood of successful surgery. Neoadjuvant treatments involve using therapies before surgery to reduce tumor size, potentially converting an inoperable tumor into one that can be surgically removed. We use a combination of systemic therapies, including cutting-edge chemotherapy and targeted agents. These therapies are carefully selected based on the tumor’s molecular profile and the patient’s overall health, offering a tailored approach that maximizes treatment efficacy.
We offer advanced locoregional treatments including transarterial chemoembolization (TACE) and transarterial radioembolization (TARE). TACE delivers chemotherapy directly to the tumor, combined with a substance that blocks its blood supply, while TARE involves delivering radioactive beads to provide targeted radiation therapy.
Minimally invasive catheter-based therapies including Yttrium-90 (Y-90) radioembolization with ablative (curative) dose radiation segmentectomy and Trans-Arterial Chemoembolization (TACE). Y-90 are performed using the latest in personalized dosimetry for better patient outcomes.
We also offer Peptide Receptor Radionuclide Therapy (PRRT), also known as Lutathera, for metastatic neuroendocrine tumors. These treatments are particularly effective in reducing tumor size and can be employed as neoadjuvant options to make tumors more favorable to surgical resection, or following surgery, when needed. Another approach uses hepatic artery infusion (HAI) pump therapy. The HAI pump is a medical device used to deliver chemotherapy directly to the liver to help shrink the tumor while minimizing side effects. Since 2021, AHN has implanted 47 HAI pumps.
Stereotactic Body Radiotherapy (SBRT)
Patients with damaged livers or lower hepatic function, such as those with HCC, need tailored treatment. SBRT offers a cutting- edge, nonsurgical technology that uses high-energy X-rays on linear accelerators (LINAC) to destroy primary or metastatic liver tumors. Our specialized approach to SRBT ensures it can be used for those waiting for liver transplants with minimal side effects.
We also use a novel MRI contrast agent called ferumoxytol for liver SRBT on MRI-LINAC. A single injection helps us see liver tumors throughout the entire organ for better targeting. At the same time, it helps us identify healthy liver tissue to avoid during treatment. We are the only cancer center in the region, and one of a few in the United States, using this innovative radiation technology in daily practice for treatment of a of
cancers.
Supportive care
Beyond medical treatment, our clinic emphasizes holistic care, ensuring that each patient receives comprehensive support throughout their treatment journey. Our commitment to compassionate, individualized care extends to every aspect of treatment, ensuring that our patients receive the best possible care tailored to their specific needs. We provide:
- Pain management
- Nutritional support
- Psychological counseling
- Rehabilitation and pre-habilitation
Clinical trials
AHN is also at the forefront of cancer research, offering patients access to clinical trials that explore new chemotherapy combinations, targeted therapies, and immunotherapy options for both HCC and biliary tumors. These trials provide opportunities to benefit from the latest advancements in cancer treatment, often before they are widely available.
Hepatocellular carcinoma FAQs
A hepatocellular carcinoma (HCC) diagnosis is most likely an overwhelming and potentially scary diagnosis. Your AHN care team is your resource for guidance and treatment options. To help guide your conversation, we’ve compiled answers to some frequently asked questions our patients have about HCC.
What is the most common cause of liver cancer like hepatocellular carcinoma?
It can also be caused by cirrhosis, which is scarring of the liver. This can often be caused by chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), excessive alcohol consumption, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and other chronic liver conditions, although this is less common.
What is the life expectancy of a person with liver cancer?
The life expectancy of a person with liver cancer can vary greatly depending on several factors, including:
- Stage of the cancer: Early-stage liver cancer has a better prognosis than advanced-stage cancer.
- Overall health: A person's general health and liver function significantly impact survival.
- Treatment options: Whether the cancer can be surgically removed, treated with a liver transplant, or managed with other therapies affects life expectancy.
- Type of liver cancer: Hepatocellular carcinoma (HCC) is the most common type, but other types like cholangiocarcinoma have different prognoses.
- Response to treatment: How well the cancer responds to treatment plays a crucial role.
Due to these complexities, providing a specific life expectancy is difficult without knowing the individual's circumstances. You can find survival rate statistics based on the stage of cancer, but remember, these are just averages and do not predict an individual's outcome. Your AHN care team will help you understand your specific prognosis.
Is liver cancer curable?
Whether liver cancer is curable depends on several factors, primarily the stage at which it's diagnosed and the overall health of the patient. In some cases, particularly when the cancer is detected early and is confined to the liver, treatments like surgery to remove the tumor, liver transplantation, or ablation therapies can be curative. However, if the cancer has spread beyond the liver or if the patient has other underlying health conditions, a cure may not be possible, and the focus shifts to managing the disease and improving quality of life.
What is the most common cause of hepatocellular carcinoma?
The most common cause of hepatocellular carcinoma (HCC) worldwide is cirrhosis, which is often caused by chronic infection, alcohol, or metabolic disease.
Contact us
You can call the Center of Excellence directly at 412-359-6738 or you can call the Hope Line at (412) 578-HOPE (412) 578-4673 to connect with a nurse navigator or schedule an appointment.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.