Introduction
Hepatocellular carcinoma (HCC) is said to be the seventh most common cause of cancer-related deaths in India. However, when detected early, HCC can be treated and brought into remission.
Types of Liver cancer
There are different types of Liver cancer depending on the tissue it affects. HCC is the commonest type of Liver cancer.
- Hepatocellular carcinoma (HCC)
- Bile duct cancer
- Hepatoblastoma
Causes and risk factors
The major risk factors of HCC are
- Chronic Hepatitis due to infection with Hepatitis B or Hepatitis C
- Alcoholic liver cirrhosis
- Aflatoxin B, a type of fungus found in groundnuts and peanuts
- NAFLD (Non-alcoholic fatty liver disease) and NASH (Non-alcoholic steatohepatitis)
Some minor factors depend on
- Age, more common in the older population
- Sex, more common in men
- Oral contraceptive use
- Cigarette smoking
- Hereditary disorders like Wilson’s disease, hereditary hemochromatosis, alpha 1 antitrypsin deficiency
- Obesity, high cholesterol levels, Diabetes mellitus and Hypertension
Alcohol intake along with cigarette smoking have a synergistic effect and increases the risk for HCC multifold.
NAFLD and NASH are Fatty liver diseases that develop due to Obesity, high cholesterol levels or metabolic syndromes. These can also lead to progressive changes in the Liver, thereby posing a high risk for HCC. This is why lifestyle changes and diet play an important role in preventing HCC.
Symptoms
The early stages of the HCC often do not produce any symptoms. The symptoms of HCC can vary in different patients and can present as,
- Vague pain or fullness in the upper abdomen
- Loss of weight and appetite
- Malaise
- Yellowish discolouration of the skin
- Nausea and vomiting
- Abdominal swelling
- Clay-coloured stools
- Upper and lower Gastrointestinal bleed - Blood in vomit, dark-coloured stools
- Fever
- Itching
As cancer progresses, the patient can also develop infections and show signs of liver cell failure like Altered mental status, Fever, signs of bleeding and Dilated vein in the abdomen.
Diagnosis
- Blood investigations like Complete Blood Count, Liver Function Test and renal functions.
- Tumour markers such as AFP ( not specific to HCC).
- Imaging such as USG abdomen, CT or MDCT abdomen, MRI
- PET CT
- Biopsy
Treatment
Medical management
1. Chemotherapy
2. Immune-mediated therapy
3. Radiotherapy
4. TACE
Surgical management
1. Radio-frequency ablation
2. Surgical resection of the tumour
Management of HCC depends on the staging of cancer. The early-stage cancers can be usually treated with resection of the area affected by the tumour or by Radio-frequency ablation of the tumour.
More progressive stages of cancer are treated through chemotherapy. The advanced stages of cancer are managed by palliative care.
Liver transplant in HCC is still not done frequently as it poses a risk for multiple complications and poor prognosis. The presence of multiple comorbidities, multiple tumours, presence of any vascular invasion or any metastatic spread is deterring factor that indicates the patient is not a good candidate for a liver transplant.
In the absence of these changes, if the patient fits into the criteria, patients with early stages of cancer can be evaluated for a liver transplant.
However, the need for long-term immunosuppression or adverse events during surgery might outweigh the risk versus benefit.
Prevention
Early detection and diagnosis play a key role in managing this disease. Cutting down some of the risk factors can help in preventing the onset of Liver disease, which in turn reduces the risk of forming HCC.
1. To stop excessive alcohol intake
2. Cessation of smoking
3. Healthy and balanced diet
4. Daily exercise and physical activity
5. Maintaining ideal body weight
6. Adequate sleep and rest
7. Vaccination against Hepatitis B and C
8. Safe sex practices
9. Avoid using or sharing needles/syringes
If there is already a family history of cancers or a person has any disease or illness that poses a high risk of developing Liver cancer, then yearly health check-ups can be done for screening.
Keeping other risk factors such as Diabetes, Hypertension, and cholesterol levels in check can also play a key role in preventing any liver diseases such as NASH or NAFLD from developing.
Conclusion
HCC is the commonest type of Liver cancer that is prevalent in Asia. HCC can develop due to many causes, but the commonest cause remains due to Alcoholic liver disease, NASH and chronic Hepatitis B and C infections. Preventing the onset of liver disease by maintaining a healthy lifestyle and diet plays a key factor in preventing cancer.
