Hepatocellular Carcinoma (HCC)

What is hepatocellular carcinoma (HCC)?

Hepatocellular carcinoma is the most common form of liver cancer. It’s an aggressive (fast-growing) cancer most common in people with advanced liver disease, like cirrhosis of the liver. Increasingly, people diagnosed with HCC have a liver condition that sometimes leads to cirrhosis called metabolic dysfunction-associated steatotic liver disease (MASLD).

In the beginning, hepatocellular carcinoma grows slowly. Surgery to remove the tumor or a liver transplant can treat HCC in its early stages. But most people don’t learn they have it until it’s advanced and spreading more quickly. Eventually, it can lead to liver failure. At this point, HCC is challenging for providers to treat.

Given how serious it is, you should receive regular checks for signs of HCC if you have cirrhosis or MASLD.

How common is HCC?

HCC accounts for about 85% to 90% of all primary liver cancers. “Primary” means the cancer starts in your liver (as opposed to spreading to your liver, as with metastatic cancer). It’s the sixth most common type of cancer diagnosis and the third leading cause of cancer-related deaths.

HCC is two to three times more common in men and people assigned male at birth (AMAB). Most people diagnosed are 60 or older.

What are the symptoms of hepatocellular carcinoma?

Tumors may not cause symptoms in the early stages. But as HCC progresses, you may notice:

• Fullness or a knot under your ribs on your right side (symptoms of an enlarged liver).
• Fullness under your ribs on your left side (symptoms of an enlarged spleen).
• Eyes and skin turning yellow (signs of jaundice).
• A stomach that feels swollen, like it’s filling up with fluid.
• Loss of appetite or feeling full after a small meal.
• Unexplained weight loss.
• Nausea and vomiting.
• Itching.

Many conditions cause similar symptoms, and most aren’t as serious as hepatocellular cancer. So, try not to panic if you experience one or more of them. But if symptoms last longer than two weeks, it’s best to see a healthcare provider.

What causes hepatocellular carcinoma?

Most people diagnosed with HCC have cirrhosis of the liver (approximately 80%) although some have a a condition that can lead to cirrhosis of the liver. In some instances, the condition never progresses to cirrhosis, but people still develop HCC.

With these conditions, unmanaged long-term liver inflammation can lead to severe scarring and, eventually, HCC.

Risk factors for HCC

Conditions that increase your risk of HCC include:

• Hepatitis B infection: A viral infection that spreads through bodily fluids. (Hepatitis B infection can lead to HCC even without liver cirrhosis or before cirrhosis occurs.)
• Hepatitis C infection: A viral infection that spreads through blood.
• Metabolic dysfunction-associated steatotic liver disease (MASLD): A condition that causes excess fat to build up in your liver. You’re more likely to have MASLD if you have obesity, an inherited metabolic syndrome or Type 2 diabetes.
• Alcohol use disorder: Alcohol is difficult for your liver to process. Drinking too much of it can eventually lead to cirrhosis and liver cancer.

If you belong to a high-risk group, your healthcare provider may suggest regular screenings to catch HCC early, when it’s treatable. They can also help you take steps to reduce risk factors, like helping you quit smoking or drinking. They can help you manage chronic conditions that put you at risk, like hepatitis infections and diabetes.

How is hepatocellular carcinoma diagnosed?

Your healthcare provider will do a physical exam. They’ll also ask about your medical history, symptoms and lifestyle.

Tests to help confirm a diagnosis include:

• Blood tests: Your provider may check your blood for signs of HCC, like high alpha-fetoprotein (AFP) levels. Elevated AFP may signal HCC or a condition that can lead to HCC, like a hepatitis infection or cirrhosis of the liver.
• Imaging scans: Imaging procedures, like an ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) or angiography can show tumors (or signs of a tumor) inside your liver.
• Liver biopsy: Your provider may biopsy a liver tumor to test the tissue for cancer cells. You may need this test if your bloodwork results and imaging scans aren’t definitive enough for a diagnosis.

HCC is an unusual cancer because in people with cirrhosis, providers can make the diagnosis based on the tumor(s) having certain features on an MRI or CT scan without needing to do a biopsy.

How is HCC staged?

Cancer staging for HCC allows your healthcare provider to determine how advanced it is. It also helps them plan treatments and determine your prognosis (outlook). To stage HCC, providers consider:

• How big the tumor is.
• How much it’s grown into nearby tissue (including your lymph nodes).
• Whether it’s spread beyond your liver (metastatic cancer).
• How advanced the underlying liver disease is.

How is hepatocellular carcinoma treated?

Treatments include:

• Surgery: The surgical treatments for HCC are hepatectomy (removing the diseased part of your liver) or a liver transplant. You may receive a hepatectomy if the tumor is only limited to one part of your liver. If your liver isn’t healthy enough for a hepatectomy, a liver transplant may be an option.
• Ablation therapy: Providers performing ablation use a special needle to burn tumors. The needle may direct energy that’s extremely hot (microwaves or radiofrequency waves) or freezing cold.
• Embolization: Embolization implants a substance directly into the arteries supplying the tumor, stopping blood flow. Chemoembolization implants a substance that contains chemotherapy drugs. Radioembolization implants small beads of radiation.
• Radiation therapy: Providers may recommend radiation therapy to treat small tumors that they can’t remove with surgery or destroy using ablation. Stereotactic body radiation therapy (SBRT) is a specific type of radiation treatment that providers use to treat HCC.
• Immunotherapy: Immunotherapy medicines also treat advanced HCC. They help your immune system identify and fight cancer cells.
• Targeted therapy: Targeted therapy medicines treat advanced HCC. This treatment switches off the signal that tells cancer cells to keep growing.

Your healthcare provider may suggest participating in a clinical trial to try new HCC treatments. They may also recommend palliative care to help you manage cancer symptoms and treatment side effects. Palliative care can improve your experience whether you’re living with long-term disease or receiving treatment for early-stage, curable HCC.

How can I reduce my risk of hepatocellular carcinoma?

There are several ways you can reduce your risk of developing HCC. You can:

• Get your hepatitis B vaccination, or get regular check-ups if you already have hepatitis B.
• See your healthcare provider if you think you may have been exposed to hepatitis C. (It’s curable with treatment.)
• Work with your provider to manage metabolic conditions associated with MASLD. Maintaining a weight that’s healthy for you by eating healthy foods is key.
• Cut back on the amount of alcohol you drink.
• Stop smoking if you do.

Can hepatocellular carcinoma be cured?

Surgery to remove the tumor or a liver transplant are the best options for a cure. If surgery isn’t an option, there are other treatments to ease your symptoms, slow the tumor’s growth and help you live longer.

Researchers continue to search for new ways to cure hepatocellular carcinoma that can’t be removed with surgery. In the meantime, new treatments, like immunotherapy and targeted therapy, continue to improve the life expectancy of people diagnosed with advanced HCC.

Survival rate for hepatocellular carcinoma

The five-year relative survival rate (people alive five years after their diagnosis) for people with HCC is 21%.

But many factors contribute to life expectancy, including how advanced HCC is, your liver’s overall health and your response to treatment. Some studies show that receiving care in a hospital that commonly treats HCC can improve survival rates.

Every case of HCC is different. Your healthcare provider is your best resource for offering insight into what you might expect based on your condition.

How do I take care of myself?

HCC can feel like an overwhelming diagnosis. It’s completely normal to feel uncertain about what happens next. But there are steps you can take to cope with your diagnosis and advocate for yourself.

You can:

• Keep track of questions and concerns. Asking questions about your condition and treatment helps you understand what to expect and what you can do to help yourself.
• Focus on managing stress. Cancer is stressful. Activities such as meditation, relaxation exercises or deep breathing may help ease your stress. Getting plenty of rest during this time is also essential for managing stress.
• Adjust what you eat. Your treatments might affect your appetite. Try to eat healthy meals and snacks. Talk to a nutritionist or a dietitian if you’re having trouble eating certain foods or need guidance on what foods to eat or avoid.
• Reach out for emotional support. Cancer can be lonely. Sometimes, it’s hard talking to loved ones who don’t know firsthand what it’s like living with a cancer diagnosis. Your healthcare provider can direct you to support groups where you can share your feelings with people living with cancer who better understand.

When should I see my healthcare provider?

Contact your provider if you have symptoms of HCC for two or more weeks or if existing symptoms get worse. Don’t skip check-ups if you belong to a high-risk group and your healthcare provider recommends screenings for HCC.

Catching HCC early, when surgery can treat it, delivers the best possible outcomes.

What questions should I ask my healthcare provider?

You’ll likely have several questions throughout your diagnosis and treatment. Don’t hesitate to ask any questions you have about your diagnosis, treatment or likely outcomes.

Questions to ask include:

• How well is my liver working?
• What stage is my cancer?
• Can my cancer be cured?
• What are my treatment choices?
• What are the side effects of each treatment?
• How will treatment affect my daily life?
• How will we know if treatment is working?