What is Hepatocellular Carcinoma? Symptoms, Causes, & Treatment

Hepatocellular carcinoma is the most common type of liver cancer that starts in the main liver cells called hepatocytes. This cancer develops when these cells begin growing abnormally and uncontrollably, forming tumors in your liver.

While hearing about any type of cancer can feel overwhelming, understanding hepatocellular carcinoma can help you recognize symptoms early and explore treatment options. Your liver is remarkably resilient, and medical advances have significantly improved outcomes for people with this condition.

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma, often shortened to HCC, is a cancer that begins in your liver's main working cells. Your liver contains different types of cells, but hepatocytes make up about 80% of your liver and handle most of its important functions like filtering toxins and producing proteins.

This cancer typically develops slowly over many years, often in livers that are already damaged by other conditions. Most cases occur in people who have chronic liver disease or cirrhosis, which is scarring of the liver tissue.

HCC accounts for about 75% of all primary liver cancers worldwide. The term "primary" means the cancer started in the liver itself, rather than spreading there from another part of your body.

What are the Symptoms of Hepatocellular Carcinoma?

Early hepatocellular carcinoma often doesn't cause noticeable symptoms, which is why it can be challenging to detect in its initial stages. When symptoms do appear, they may feel similar to other liver problems you might already be experiencing.

Here are the most common symptoms you might notice:

• Unexplained weight loss and loss of appetite
• Pain or discomfort in your upper right abdomen
• Feeling unusually tired or weak
• Nausea and vomiting
• Swelling in your abdomen (called ascites)
• Yellowing of your skin and eyes (jaundice)
• Feeling full quickly when eating

Some people may experience more specific symptoms as the cancer progresses. These can include swelling in your legs and feet, confusion or difficulty thinking clearly, and fever without an obvious cause.

Remember that these symptoms can occur with many other conditions, particularly if you already have liver disease. The key is paying attention to new symptoms or existing ones that suddenly get worse.

What are the Types of Hepatocellular Carcinoma?

Hepatocellular carcinoma can be classified in several ways to help doctors plan the best treatment approach. Understanding these classifications can help you better discuss your specific situation with your healthcare team.

Based on how the cancer cells look under a microscope, HCC is divided into these types:

• Well-differentiated: Cancer cells look more like normal liver cells and tend to grow slower
• Moderately differentiated: Cancer cells look somewhat different from normal cells
• Poorly differentiated: Cancer cells look very different from normal cells and may grow faster
• Undifferentiated: Cancer cells look completely abnormal and typically grow quickly

Doctors also classify HCC by its growth pattern. Some tumors grow as a single large mass, while others appear as multiple smaller nodules throughout the liver. There's also a less common type called fibrolamellar HCC that typically affects younger people who don't have underlying liver disease.

What Causes Hepatocellular Carcinoma?

Hepatocellular carcinoma develops when something damages your liver cells repeatedly over time, causing them to become cancerous. Most cases result from chronic conditions that cause ongoing inflammation and scarring in your liver.

The most common underlying causes include:

• Chronic hepatitis B infection: This viral infection can cause long-term liver damage even if you feel fine
• Chronic hepatitis C infection: Another viral infection that slowly damages liver tissue over decades
• Cirrhosis from any cause: Severe scarring of the liver that can result from various conditions
• Alcohol-related liver disease: Long-term heavy drinking can lead to liver damage and cancer
• Non-alcoholic fatty liver disease: Fat buildup in the liver that can progress to more serious conditions
• Diabetes and obesity: These conditions can contribute to fatty liver disease and inflammation

Less common causes include exposure to aflatoxins, which are toxins produced by mold that can contaminate certain foods like peanuts and corn. Some inherited conditions that affect iron or copper storage in the liver can also increase your risk.

Having one of these conditions doesn't mean you'll definitely develop liver cancer. Many people live with chronic liver disease without ever developing HCC.

When to See a Doctor for Hepatocellular Carcinoma?

You should contact your doctor if you notice any new or worsening symptoms, especially if you already have liver disease. Early detection can make a significant difference in treatment options and outcomes.

Seek medical attention promptly if you experience:

• Sudden, severe abdominal pain
• Rapid weight loss without trying
• New or worsening yellowing of your skin or eyes
• Increasing abdominal swelling
• Confusion or changes in mental clarity
• Vomiting blood or passing dark, tarry stools

If you have chronic hepatitis B, hepatitis C, or cirrhosis, regular monitoring with your healthcare provider is essential. Your doctor will likely recommend routine screening tests to check for early signs of liver cancer, even if you don't have symptoms.

Don't wait if something feels different or concerning about your health. Your healthcare team is there to help, and addressing symptoms early often leads to better outcomes.

What are the Risk Factors for Hepatocellular Carcinoma?

Understanding your risk factors can help you and your doctor make informed decisions about screening and prevention. Some risk factors you can't change, while others you may be able to modify with lifestyle adjustments and medical care.

Risk factors you cannot change include:

• Age: Risk increases with age, with most cases occurring after age 60
• Gender: Men are more likely to develop HCC than women
• Genetic conditions: Inherited disorders affecting iron or copper metabolism
• Family history: Having relatives with liver cancer may slightly increase your risk

Risk factors you may be able to influence include:

• Chronic viral hepatitis: Getting vaccinated for hepatitis B and avoiding hepatitis C exposure
• Alcohol consumption: Limiting alcohol intake can prevent alcohol-related liver disease
• Obesity and diabetes: Maintaining a healthy weight and managing blood sugar levels
• Smoking: Quitting smoking can reduce your overall cancer risk

If you have multiple risk factors, this doesn't mean you'll develop liver cancer. Many people with risk factors never develop HCC, while some people with few risk factors do. The key is working with your healthcare team to monitor your liver health and address modifiable risk factors.

What are the Possible Complications of Hepatocellular Carcinoma?

Hepatocellular carcinoma can lead to various complications, both from the cancer itself and from underlying liver disease. Understanding these possibilities can help you recognize warning signs and seek appropriate care when needed.

Common complications related to the cancer include:

• Liver failure: The cancer can interfere with your liver's ability to function properly
• Portal hypertension: Increased pressure in blood vessels leading to the liver
• Bleeding: Enlarged blood vessels in the esophagus or stomach may rupture
• Fluid accumulation: Ascites or fluid buildup in the abdomen and legs

Less common but serious complications include blood clots in liver blood vessels, kidney problems, and the cancer spreading to other parts of your body such as the lungs or bones.

Your healthcare team will monitor you carefully for these complications and can often prevent or manage them effectively when caught early. Many treatments are available to help maintain your quality of life even if complications develop.

How Can Hepatocellular Carcinoma be Prevented?

While you can't prevent all cases of hepatocellular carcinoma, you can take several steps to significantly reduce your risk. Prevention focuses mainly on protecting your liver from the conditions that commonly lead to HCC.

Here are the most effective prevention strategies:

• Get vaccinated for hepatitis B: This vaccine is highly effective and recommended for all children and high-risk adults
• Avoid hepatitis C exposure: Don't share needles, razors, or other personal items that might have blood on them
• Limit alcohol consumption: If you drink, do so in moderation or consider abstaining completely
• Maintain a healthy weight: Eat a balanced diet and exercise regularly to prevent fatty liver disease
• Manage diabetes effectively: Keep your blood sugar levels well-controlled if you have diabetes
• Avoid exposure to aflatoxins: Store grains and nuts properly and avoid moldy foods

If you already have chronic liver disease, working closely with your healthcare team to manage your condition is crucial. This includes taking medications as prescribed, attending regular checkups, and following screening recommendations.

Remember that prevention is most effective when started early, but it's never too late to make positive changes for your liver health.

How is Hepatocellular Carcinoma Diagnosed?

Diagnosing hepatocellular carcinoma involves several steps to confirm the presence of cancer and determine its extent. Your doctor will use a combination of tests to get a complete picture of your condition.

The diagnostic process typically begins with blood tests to check your liver function and look for tumor markers. Alpha-fetoprotein (AFP) is a protein that may be elevated in people with HCC, though not everyone with liver cancer has high AFP levels.

Imaging tests play a crucial role in diagnosis:

• Ultrasound: Often the first imaging test used to look at your liver
• CT scan: Provides detailed pictures of your liver and can show the size and location of tumors
• MRI: Offers very detailed images and can help distinguish HCC from other liver problems
• Angiography: Shows blood vessels in and around the liver

In some cases, your doctor may recommend a liver biopsy, where a small sample of liver tissue is removed and examined under a microscope. However, imaging tests are often sufficient for diagnosis, especially when combined with your medical history and blood test results.

The entire diagnostic process may take several weeks, which can feel stressful. Your healthcare team understands this and will keep you informed throughout the process.

What is the Treatment for Hepatocellular Carcinoma?

Treatment for hepatocellular carcinoma depends on several factors including the size and number of tumors, your overall liver function, and your general health. Your healthcare team will work with you to develop a personalized treatment plan.

For early-stage HCC, curative treatments may include:

• Surgical resection: Removing the part of the liver containing the cancer
• Liver transplantation: Replacing your entire liver with a healthy donor liver
• Ablation: Destroying cancer cells using heat, cold, or alcohol injections

For more advanced cases, treatment options include:

• Transarterial chemoembolization (TACE): Delivering chemotherapy directly to the tumor while blocking its blood supply
• Targeted therapy: Medications that specifically target cancer cells
• Immunotherapy: Treatments that help your immune system fight the cancer
• Radiation therapy: High-energy beams that destroy cancer cells

Your oncologist will explain which treatments are most appropriate for your specific situation. Many people receive a combination of treatments, and new therapies are continually being developed and tested.

How to Take Home Treatment During Hepatocellular Carcinoma?

Managing hepatocellular carcinoma at home involves taking care of your overall health while supporting your medical treatment. Your comfort and quality of life are important priorities throughout your treatment journey.

Focus on nutrition by eating small, frequent meals if you have a poor appetite. Choose foods that are easy to digest and high in protein to help maintain your strength. Stay hydrated, but follow any fluid restrictions your doctor may recommend if you have fluid retention.

Helpful home care strategies include:

• Rest when needed: Listen to your body and don't push yourself too hard
• Stay active gently: Light walking or stretching can help maintain your energy
• Manage symptoms: Take prescribed medications for pain, nausea, or other symptoms
• Avoid alcohol completely: Even small amounts can further damage your liver
• Practice stress management: Consider meditation, deep breathing, or other relaxation techniques

Keep track of your symptoms and any side effects from treatment. This information helps your healthcare team adjust your care as needed. Don't hesitate to call your doctor if you have concerns or if symptoms worsen.

Consider joining a support group or connecting with others who have similar experiences. Emotional support is just as important as physical care during this time.

How Should You Prepare for Your Doctor Appointment?

Preparing for appointments with your healthcare team can help you make the most of your time together and ensure you get the information and care you need. Good preparation can also help reduce anxiety about medical visits.

Before your appointment, write down all your current symptoms, including when they started and how they've changed. Note any medications you're taking, including over-the-counter drugs and supplements, as some can affect your liver.

Prepare these important items:

• List of questions: Write down everything you want to ask, from treatment options to side effects
• Medical records: Bring any test results, imaging studies, or reports from other doctors
• Medication list: Include dosages and how often you take each medication
• Insurance information: Have your insurance cards and any referral forms ready
• Support person: Consider bringing a family member or friend to help remember information

Don't worry about asking too many questions. Your healthcare team wants to help you understand your condition and treatment options. If you don't understand something, ask for clarification or request that information be explained in different terms.

Take notes during the appointment or ask if you can record the conversation. Having accurate information to review later can be very helpful when making treatment decisions.

What's the Key Takeaway About Hepatocellular Carcinoma?

Hepatocellular carcinoma is a serious condition, but understanding it empowers you to work effectively with your healthcare team. Early detection through regular screening, especially if you have risk factors, can significantly improve treatment options and outcomes.

The most important thing to remember is that treatment options have improved dramatically in recent years. Many people with HCC can maintain a good quality of life, and some achieve long-term remission or cure, particularly when the cancer is caught early.

Your relationship with your healthcare team is crucial throughout this journey. Stay engaged in your care, ask questions, and don't hesitate to seek second opinions if you feel it would be helpful. Support from family, friends, and patient organizations can make a meaningful difference in your experience.

Focus on what you can control, such as following your treatment plan, maintaining good nutrition, and taking care of your emotional well-being. Remember that having hope and staying informed are powerful tools in managing any health challenge.