Hepatocellular carcinoma is cancer of the liver.

Hepatocellular carcinoma accounts for 80 - 90% of all liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people ages 50 - 60.

The disease is more common in parts of Africa and Asia than in North or South America and Europe.

Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (breast or colon) and spreads to the liver.

The cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by:

• Alcohol abuse (the most common cause in the U.S.)
• Certain autoimmune diseases of the liver
• Diseases that cause long-term swelling and irritation (chronic inflammation) of the liver
• Hepatitis B and C
• Too much iron in the body (hemochromatosis)

Patients with hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis.

• Abdominal pain or tenderness, especially in the upper-right part
• Easy bruising or bleeding
• Enlarged abdomen
• Yellow skin and eyes (jaundice)

Physical examination may show an enlarged, tender liver.

Tests include:

• Abdominal CT scan
• Liver biopsy
• Liver enzymes (liver function tests)
• Liver scan
• Serum alpha fetoprotein

Some high-risk patients may get periodic blood tests and ultrasounds to see if tumors are developing.

Aggressive surgery or a liver transplant may successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early.

Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumors so that surgery has a greater chance of success.

Sorafenib toslate (Nexavar), a medicine that blocks tumor growth, is now available for patients with liver tumors.

You can ease the stress of illness by joining a support group with members who share common experiences and problems. See:

• Cancer - support group
• Liver disease - support group

The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery.

If the cancer cannot be completely removed, the disease is usually deadly within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.

• Gastrointestinal bleeding
• Liver failure
• Spread (metastasis) of the carcinoma

Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease.

Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.

Avoid drinking excessive amounts of alcohol. Certain patients may benefit from hemochromatosis screening.

Kew MC. Hepatic tumors and cysts. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 91.