Introduction

Hepatocellular carcinoma (HCC) is the third most common cause of cancer worldwide. Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.

Epidemiology

  • Incidence: 9.00 cases per 100,000 person-years
  • Peak incidence: 60-70 years
  • Sex ratio: more common in males 1.7:1
Condition Relative
incidence
Hepatocellular carcinoma1
Cholangiocarcinoma0.19
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

The main risk factor for developing HCC is liver cirrhosis, for example secondary to hepatitis B & hepatitis C, alcohol, haemochromatosis and primary biliary cirrhosis. Other risk factors include:
  • alpha-1 antitrypsin deficiency
  • hereditary tyrosinosis
  • glycogen storage disease
  • aflatoxin
  • drugs: oral contraceptive pill, anabolic steroids
  • porphyria cutanea tarda
  • male sex
  • diabetes mellitus, metabolic syndrome

Clinical features

Features
  • tends to present late
  • features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
  • possible presentation is decompensation in a patient with chronic liver disease

Referral criteria

NICE cancer referral guidelines for liver cancer suggest the following:


Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for liver cancer in people with an upper abdominal mass consistent with an enlarged liver.

Management

Management options
  • early disease: surgical resection
  • liver transplantation
  • radiofrequency ablation
  • transarterial chemoembolisation
  • sorafenib: a multikinase inhibitor

Screening and prevention

Screening with ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as: