Liver cell carcinoma (LCC), commonly known as hepatocellular carcinoma (HCC), is the most prevalent primary liver cancer. It arises from hepatocytes and is often associated with chronic liver diseases such as cirrhosis and hepatitis infections. The disease has a poor prognosis if not detected early, making timely diagnosis and treatment crucial for patient survival.
Causes and Risk Factors of Liver Cell Carcinoma
1. Chronic Liver Diseases
✔ Hepatitis B and C Virus (HBV/HCV) Infection: Persistent viral infections cause inflammation and fibrosis, leading to carcinogenesis.
✔ Cirrhosis: Chronic liver damage from alcohol, nonalcoholic fatty liver disease (NAFLD), or hepatitis increases cancer risk.
2. Lifestyle and Environmental Factors
✔ Alcohol Consumption: Excessive alcohol intake leads to liver scarring, which predisposes patients to HCC.
✔ Aflatoxin Exposure: Contaminated food (e.g., grains and nuts) with Aspergillus fungus produces carcinogenic aflatoxins.
✔ Obesity and Metabolic Syndrome: NAFLD and diabetes mellitus contribute to liver steatosis and fibrosis, raising cancer risk.
✔ Genetic Factors: Certain inherited metabolic disorders (e.g., hemochromatosis) can trigger liver malignancy.
Symptoms and Clinical Presentation
1. Early-Stage Symptoms
✔ Asymptomatic or mild fatigue
✔ Unintentional weight loss
✔ Right upper quadrant discomfort
✔ Loss of appetite and nausea
2. Advanced-Stage Symptoms
✔ Jaundice (yellowing of the skin and eyes)
✔ Abdominal swelling (ascites)
✔ Palpable liver mass
✔ Gastrointestinal bleeding (hematemesis or melena)
✔ Severe weakness and cachexia
Patients with underlying liver disease should undergo regular surveillance to detect early-stage HCC, as symptoms often manifest late.
Diagnosis of Liver Cell Carcinoma
1. Blood Tests
- Alpha-Fetoprotein (AFP): Elevated in 50-70% of HCC cases, but not specific.
- Liver Function Tests (LFTs): Assess bilirubin, AST, ALT, and albumin levels.
- Hepatitis Serology: Identifies HBV or HCV co-infection.
2. Imaging Modalities
✔ Ultrasound (USG): First-line screening tool for cirrhotic patients.
✔ CT Scan (Multiphasic): Detects arterial-phase enhancement with washout.
✔ MRI with Contrast: Characterizes tumor vascularity and necrosis.
✔ PET-CT Scan: Used for staging and metastasis detection.
3. Liver Biopsy
✔ Indicated in cases with inconclusive imaging findings.
✔ Confirms histopathological diagnosis.
Staging and Prognostic Factors
Liver cell carcinoma staging guides treatment decisions and prognosis. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used.
| Stage | Tumor Size & Spread | Treatment Options | Survival Rate |
|---|---|---|---|
| 0 (Very Early) | Single tumor <2 cm, no vascular invasion | Resection or liver transplant | >70% (5-year) |
| A (Early) | Single tumor <5 cm or 3 tumors <3 cm | Resection, ablation, transplant | 50-70% |
| B (Intermediate) | Multiple nodules | Transarterial chemoembolization (TACE) | 20-40% |
| C (Advanced) | Invasion of major vessels, metastasis | Systemic therapy (TKIs, immunotherapy) | 10-20% |
| D (End-Stage) | Severe liver dysfunction | Supportive care | <5% |
Treatment Options for Liver Cell Carcinoma
1. Surgical Treatment
✔ Liver Resection (Partial Hepatectomy): Preferred for non-cirrhotic patients with localized tumors.
✔ Liver Transplantation: Ideal for patients meeting Milan Criteria (single tumor <5 cm or up to 3 tumors <3 cm each).
2. Non-Surgical Localized Therapies
✔ Radiofrequency Ablation (RFA): Uses heat energy to destroy tumors ≤3 cm.
✔ Transarterial Chemoembolization (TACE): Delivers chemotherapy directly into hepatic arteries, effective for unresectable tumors.
✔ Transarterial Radioembolization (TARE): Uses radioactive microspheres to target liver tumors.
3. Systemic Therapy
✔ Tyrosine Kinase Inhibitors (TKIs):
- Sorafenib, Lenvatinib – First-line treatment for advanced HCC.
- Regorafenib, Cabozantinib – Second-line options for progression.
✔ Immunotherapy:
- Checkpoint Inhibitors (e.g., Atezolizumab + Bevacizumab) – Effective for advanced cases.
✔ Chemotherapy:
- Used rarely; systemic cytotoxic agents have limited efficacy in HCC.
Prevention and Risk Reduction Strategies
1. Hepatitis Prevention and Vaccination
✔ HBV vaccination reduces risk significantly.
✔ Antiviral therapy (Tenofovir, Entecavir) prevents progression to cirrhosis.
2. Lifestyle Modifications
✔ Avoid excessive alcohol intake.
✔ Maintain a healthy weight and control diabetes.
✔ Reduce consumption of aflatoxin-contaminated food.
3. Surveillance for High-Risk Individuals
✔ Biannual Ultrasound and AFP Testing – Recommended for cirrhotic patients and HBV/HCV carriers.
Complications of Liver Cell Carcinoma
✔ Tumor Rupture: Leads to life-threatening hemorrhage.
✔ Portal Vein Thrombosis: Obstructs blood flow, worsening liver function.
✔ Metastatic Spread: Common in lungs, bones, and adrenal glands.
✔ Liver Failure: Occurs in advanced stages, limiting treatment options.
Liver cell carcinoma is a highly aggressive malignancy linked to chronic liver diseases such as hepatitis and cirrhosis. Early diagnosis via imaging and AFP testing is critical for improved survival. Treatment depends on disease stage, ranging from curative surgery and liver transplantation to locoregional and systemic therapies. Preventive strategies, including hepatitis vaccination, alcohol moderation, and regular screening, are essential to reduce disease burden.
