Hepatocellular carcinoma (HCC, also called hepatoma) is a primary malignancy (cancer) of the liver. Most cases are secondary to either hepatitis infection (usually hepatitis B or C) or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis).
Treatment options and prognosis are dependent on many factors but especially on tumor size and staging.
In Sub-Saharan Africa the commonly accepted prognosis is a median survival of 3 months from diagnosis. However, this is due to late presentation with large tumours.
Epidemiology
The epidemiology of HCC exhibits two rough patterns, one in the Third World and another in the West.
Third World
In some parts of the world, such as Sub-Saharan Africa and Southeast Asia (and especially Taiwan and China) HCC is the commonest cancer, generally affecting men more than women, and with an age of onset between late teens and 30's. This variability is in part due to the different patterns of Hepatitis B transmission in different populations - infection at or around birth (as in Taiwan) predispose to earlier cancers than if people are infected later. The time between hepatitis B infection and development into HCC can be years even decades, but from diagnosis of HCC to death the average survival period is only 5.9 months, according to one Chinese study during the 1970-80s. HCC is one of the deadest cancers in China. Another unique type of HCC is not developed from Hepatitis B, but by eating Aspergillus flavus-infected food (especially peanuts and corns stored during prolonged wet seasons) which produces aflatoxin, a poison proven to increase risk of HCC.
Western countries
Most malignant tumors of the liver discovered in Western patients are metastases (spread) from tumors elsewhere. In the West, HCC is generally seen as rare cancer, normally of those with pre-existing liver disease. It is often detected by ultrasound screening, and so presents to health-care facilities much earlier than in Sub-Saharan Africa, for example.
Diagnosis, screening and monitoring
In the western world, hepatocellular carcinoma (HCC) most commonly appears in a patient with chronic viral hepatitis (hepatitis B or hepatitis C, 20%) or with cirrhosis (about 80%). These patients commonly undergo surveillance with ultrasound due to the cost-effectiveness.
In patients with a higher suspicion of HCC (such as rising alpha-fetoprotein levels), the best method of diagnosis involves a CT scan of the abdomen using intravenous contrast agent and three-phase scanning (before contrast administration, immediately after contrast administration, and again after a delay) to increase the ability of the radiologist to detect small or subtle tumors. It is important to optimize the parameters of the CT examination, because the underlying liver disease that most HCC patients have can make the findings more difficult to appreciate.
Common Cancer Types
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