Hepatocellular carcinoma (HCC) or cancer of the liver is a malignant liver tumour. It develops from liver cells (hepatocytes).

Causes of HCC

HCC most frequently develops in a cirrhotic liver. Its development is also favoured by viral hepatitis B and C, haemochromatosis, androgens, or aflatoxins, which are formed by moulds.

The development of HCC can take different lengths of time. In the case of liver cirrhosis, it can take years to decades for HCC to develop. However, liver cancer can grow rapidly and become fatal within months or a few years. The treatment options and chances of survival depend on the stage of the tumour, general state of health and stage of the liver disease.

Symptoms

The symptoms vary greatly and can range from hardly any discomfort to yellow colouration, nausea, and pain. People with chronic liver disease should have regular imaging of the liver using ultrasound or MRI. The elevated tumour marker AFP (alpha-fetoprotein) in the blood can also indicate HCC.

Diagnosis

The suspected diagnosis is confirmed by an MRI performed with a special contrast agent (Primovist). In very rare cases, a puncture of the tumour is also required to examine the tissue.

A strongly elevated AFP tumour marker is also evidence of the presence of HCC. Liver values, blood coagulation and a blood count can provide additional information on liver function and general health.

Treatment

The course and treatment options vary depending on the location and stage of the tumour. In the early stages, there is often the possibility of a cure, while in advanced stages the growth can only be controlled and the lifespan extended. Individual advice from a specialist tumour board in an appropriate centre is essential for every patient.

The treatment options vary greatly. In the best case, HCC can be eliminated by surgically removing (resecting) the tumour-bearing part of the liver. Alternatively, the tumour can also be destroyed by local procedures, which can also lead to healing in the case of very small tumours. If the HCC is confined to the liver, the possibility of a liver transplant should also be considered, which will simultaneously eliminate the chronic liver disease causing the tumour.

If resection or transplantation is not possible, cancer growth can be controlled for a certain amount of time using localised procedures. These include radiofrequency ablation (RFA), microwave ablation (MWA) or transarterial chemoembolisation (TACE). Stereotactic radiotherapy (SBRT) can also be used.
In the case of advanced HCC and/or metastases to other organs, various systemic therapies are available, e.g. tyrosine kinase inhibitors (TKI), antibody therapies and/or immunotherapies. New therapeutic approaches are still being researched in studies.

In advanced stages of cirrhosis, especially in the Child-Pugh B stage, HCC therapies are more limited. In the final stage of cirrhosis or advanced liver cancer, only the symptoms are treated.