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Hepatocellular Carcinoma

By Howard J. Worman, M. D.

Hepatocellular carcinoma is cancer that arises from hepatocytes, the major cell type of the liver. Hepatocellular carcinoma is relatively rare in the United States. Worldwide, however, it is either the number one or number two cause of cancer death. It is especially prevalent in parts of Asia and Africa. About 80% of people with hepatocellular carcinomas have cirrhosis. Chronic infection with the hepatitis B virus and hepatitis C virus also increases the risk of developing hepatocellular carcinoma. Aflatoxins, which are produced by a mold that is a contaminant of nuts (most commonly peanuts), grains, and beans, have also been implicated as a major risk factor for causing hepatocellular carcinoma. Although virtually non-existent in the United States, aflatoxins, are common in other parts of the world and often contaminate food.

Most hepatocellular carcinomas are first suspected based on the results of CAT scans or ultrasound scans. Blood alpha-fetoprotein is a useful marker for the diagnosis of hepatocellular carcinoma. About 70% of patients with hepatocellular carcinoma have elevated blood alpha-fetoprotein concentrations; however, it is not specific for this condition. It is often measured as a part of screening in patients with chronic hepatitis B or chronic hepatitis C and cirrhosis. A rising blood alpha-fetoprotein concentration in someone with chronic liver disease suggests the development of hepatocellular carcinoma. Appropriate adiological scans should be done in such instances.

The definitive diagnosis of hepatocellular carcinoma is made by biopsy. Usually, the liver mass is biopsied by a radiologist under with the help of a radiological scan. Sometimes, the mass is biopsied using a laprascope, a fiber optic instrument that is inserted into the abdomen. Occasionally, open surgical biopsy is necessary.

Hepatocellular carcinoma is curable by surgery only if the tumor is small. Liver transplantation may also be curative for relatively small tumors. Surgery or liver transplantation may not be possible in all cases, usually if the tumor is very large or has spread beyond the liver. For large tumors or cancer that has spread beyond the liver, chemotherapy, ligating (tying) or embolization (clotting) of the hepatic artery, alcohol injection into the tumor, or radiation may relieve symptoms and prolong life, but these procedures are not curative.

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Copyright, 2002, Howard J. Worman, M. D. All rights reserved. Printing or other reproduction is prohibited without the written authorization of Howard J. Worman.
Diseases of the Liver/Howard J. Worman, M. D./hjw14@columbia.edu