Hepatocellular carcinoma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hepatocellular carcinoma (HCC) usually arises in patients with liver cirrhosis due to any cause.
A significant number of patients may be asymptomatic and are diagnosed following screening.
Patients at risk of HCC should receive surveillance with an ultrasound of the liver and alpha fetoprotein at 6-month intervals.
Treatment is guided by staging and prognosis. Treatment options include resection, transplantation, percutaneous ablation therapy, chemoembolization, and systemic immunotherapy.
Atezolizumab plus bevacizumab, or durvalumab plus tremelimumab are the first-line agents for advanced-stage HCC.

MRI: hypervascularity on the arterial phase

From the personal collection of Badar Muneer MD, Florida Hospital Transplant Center, Orlando, FL; used with permission

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Partial liver resection specimen showing a well-circumscribed, solid, and relatively homogenous HCC tumor nodule
This female Cambodian patient presented with a distended abdomen due to HCC resulting from chronic hepatitis B infection
MRI: hypervascularity on the arterial phase
MRI: washout portal phase
MRI: following transarterial chemoembolization treatment
Medium power microscopic view of a hematoxylin and eosin stained section depicting normal liver on the right and HCC on the left. A sharp boundary separates the distinct zones of normal liver and tumor
High-power view of hematoxylin and eosin stained section of a well-differentiated HCC. Predominantly a solid pattern of growth with some nesting of malignant cells, separated by compressed sinusoids; some cells have clearing of the cytoplasm

Citations

Key Articles

Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023 Dec 1;78(6):1922-65.[Abstract][Full Text]
Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29 (suppl 4):iv238-55.[Abstract][Full Text]
European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236.[Abstract][Full Text]
Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline. J Clin Oncol. 2020 Dec 20;38(36):4317-45.[Abstract][Full Text]
Su GL, Altayar O, O'Shea R, et al. AGA clinical practice guideline on systemic therapy for hepatocellular carcinoma. Gastroenterology. 2022 Mar;162(3):920-34.[Abstract][Full Text]

Other Online Resources

UNOS: patient education

Referenced Articles

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