Hepatocellular Carcinoma (HCC)

What is hepatocellular carcinoma (HCC)?

Hepatocellular carcinoma is the most common form of liver cancer. It is a serious illness that can be life-threatening. If it diagnosed early, hepatocellular carcinoma can be treated with surgery to remove the cancerous tumor or with a liver transplant. Other treatments can shrink the tumor or slow its growth and relieve your symptoms. Hepatocellular carcinoma is linked to cirrhosis of the liver and non-alcohol related fatty liver disease (NAFLD). People who have cirrhosis or NAFLD should be regularly checked for signs of hepatocellular carcinoma.

How does hepatocellular carcinoma affect my body?

Over time, hepatocellular carcinoma can cause liver failure. Before that happens, however, hepatocellular carcinoma can keep your liver from managing your body’s vital functions. Among other things, your liver:

• Keeps track of your body’s nutrients, converting them into substances your body can use, storing and delivering them to your cells as needed.
• Gathers toxic substances, making sure they are harmless or released from your body.
• Supports healthy blood flow, producing substances that help your blood to clot and removing bacteria that cause infection.

Who does it affect?

Men ages 60 and older are more likely to develop hepatocellular carcinoma than women and younger men.

How common is hepatocellular carcinoma?

With approximately six new cases a year per 100,000 people in the United States, hepatocellular carcinoma is considered a relatively rare form of cancer. Hepatocellular carcinoma accounts for about 85%-90% of all primary liver cancers, meaning cancers that start in your liver and not another area of your body.

Is hepatocellular carcinoma the same as liver cancer?

There are several types of liver cancer. Hepatocellular carcinoma is the most common form of liver cancer.

Can hepatocellular carcinoma be cured?

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

Is hepatocellular carcinoma a fast-growing cancer?

In the beginning, hepatocellular carcinoma grows very slowly. It can take years before you notice any symptoms. Hepatocellular carcinoma growth speeds up as it progresses.

What is the life expectancy of a person with hepatocellular carcinoma?

Every case of hepatocellular carcinoma is different. Your prognosis — or expected outcome — depends on several factors. Talk to your healthcare provider about your individual situation. They’ll have specific insight into your condition and what you might expect.

What are symptoms of hepatocellular carcinoma?

There are many conditions with the same symptoms as hepatocellular carcinoma. Having one or more of these symptoms doesn’t mean you have hepatocellular carcinoma. But talk to your healthcare provider if you have these symptoms. They’ll identify and treat the condition that caused your symptoms. Potential hepatocellular symptoms include:

• You’re losing weight without trying.
• You feel very full after a small meal, or you don’t have much appetite.
• You’re nauseous and vomiting.
• You notice a fullness or knot under your ribs on your right side. This might indicate your liver is enlarged.
• You notice fullness under your ribs on your left side. This might be a sign your spleen is enlarged.
• You have stomach pain or pain near your right shoulder blade.
• Your stomach feels swollen, as if it’s filling up with fluid.
• Your skin itches.
• Your eyes and skin are turning sallow or yellow. This might be a sign you have jaundice.

What causes hepatocellular carcinoma?

Cirrhosis of the liver is the most common cause of hepatocellular carcinoma. Increasingly, healthcare providers are seeing hepatocellular carcinoma cases in people who have non-alcohol related fatty liver disease (NAFLD). There are other medical conditions and activities that increase your risk of developing hepatocellular carcinoma.

• Hepatitis B.
• Hepatitis C.
• Type 2 diabetes.
• Smoking.
• Having obesity.
• Excessive alcohol consumption.

If you have or have had any of these illnesses, talk to your healthcare provider about being screened for hepatocellular cancer. If you smoke, have obesity or drink a lot of alcohol, your provider can help you improve your health and decrease your risk of developing hepatocellular carcinoma.

How is hepatocellular carcinoma diagnosed?

Healthcare providers will do a medical examination and ask about your medical history, including past illnesses and activities that might increase your risk.

They might also do the following tests:

• X-rays.
• Magnetic resonance imaging (MRI).
• Ultrasound.
• Computed tomography (CT) scan.
• Angiography.
• Bone scan.
• Biopsy.
• Blood, blood chemistry and blood clotting.
• Liver function.
• Kidney function (blood tests to see how well your kidneys remove waste products).

How is hepatocellular carcinoma treated?

There are several ways to treat hepatocellular carcinoma. Your healthcare providers will develop a treatment plan that takes into account your overall health, whether your liver is working well and your tumor’s size.

Beyond that, they’ll talk to you about treatment goals, options and potential side effects. They want you to have a complete picture of your situation so you can feel confident about your decisions. Once they’ve shared information, they’ll ask about your personal preferences. Your final treatment plan will reflect your provider’s recommendations and your preferences.

What are the surgical treatments for hepatocellular carcinoma?

The surgical treatments are hepatectomy and liver transplantation. Hepatectomies are usually done when your liver is working well and your tumor is limited to one part of your liver.

What are other treatments for hepatocellular carcinoma?

Other treatments are:

• Ablation therapy. Your healthcare provider uses a special needle to burn your tumors.
• Embolization therapy or chemoembolization therapy. Healthcare providers inject chemotherapy drugs into your liver’s main artery, which carries the drugs to your tumor. Then they temporarily block your artery so the drugs stay in your tumor longer.
• Targeted therapy. This treatment blocks the growth of cancer cells and limits damage to healthy cells by targeting the cancer cells’ genes.
• Immunotherapy.
• Radiation therapy.

How can I reduce the risk I’ll develop hepatocellular carcinoma?

Fortunately, there are several ways you can reduce your risk of developing hepatocellular carcinoma:

• Get your hepatitis B vaccination. There isn’t a vaccine for hepatitis C.
• Talk to your healthcare provider if you think you might have hepatitis B and hepatitis C.
• Cut back on the amount of alcohol you drink.
• Maintain a weight that's healthy for you.

Can I have an infection that increases my risk and not realize it?

Having hepatitis C is a risk factor for hepatocellular carcinoma. You could have hepatitis C without having symptoms or knowing you’ve been infected. Some activities and medical conditions increase your risk of hepatitis C infection. Talk to your healthcare provider if:

• You’ve had unprotected sex within the past six months, shared needles for drug use within the past six months or you’ve ever injected drugs.
• You have HIV.
• You were or are on long-term hemodialysis.
• You were born from 1945 through 1965. Most people in the United State who have hepatitis C were born in these years.
• You had a blood clotting problem before 1987 that was treated with medication.
• You received a blood transfusion or organ transplant before July 1992. This is when healthcare providers started screening blood and organ donations for hepatitis C.

Can hepatocellular carcinoma be cured?

Researchers continue to search for ways to cure hepatocellular carcinoma. If your condition was diagnosed early on, you might be treated with surgery to remove the tumor. You might have a liver transplant. People whose condition was diagnosed later can still have treatment and support that helps them to live longer and to have a good quality of life.

How do I take care of myself?

It’s very hard to hear you have a life-threatening illness like hepatocellular carcinoma. It is completely normal to feel overwhelmed, anxious and even afraid. Give yourself and your loved ones some time to work through your initial emotions. Share your feelings with your healthcare provider. They’ll have suggestions to help you cope with your cancer diagnosis. Here’s some steps you can take:

• Keep track of your questions and concerns about your condition and your treatment. Asking questions helps you understand what to expect and what you can do to help yourself.
• Cancer is stressful. You might find activities such as meditation, relaxation exercises or deep breathing help to ease your stress.
• Your treatments might affect your appetite. Try to eat a healthy diet, and talk to a nutritionist if you’re having trouble eating.
• Get plenty of rest.
• Cancer can be lonely. Sometimes it’s hard talking to loved ones about your condition. Your healthcare provider can direct you to support groups and programs where you can share your thoughts and feelings with people who understand what you’re going through.

When should I see my healthcare provider?

Contact your provider if your existing symptoms get worse, or you notice new symptoms.

When should I go to the emergency room?

Hepatocellular carcinoma can cause unusual or excessive bleeding. Go to the emergency room or seek immediate medical attention if you begin to bleed from bumps and bruises, or from your rectum.

What questions should I ask my doctor?

You will have different questions throughout your diagnosis and treatment. Some initial questions you might want to ask are:

• How well is my liver working?
• Has my cancer spread beyond my liver?
• Can my cancer be cured?
• What are my treatment choices?
• Why do you suggest these choices?
• What are the side effects of each treatment?
• How will each treatment affect my daily life?
• How quickly do we need to decide on treatment?
• How will we know if treatment is working?
• What are my options if the initial treatments don’t work?

A note from Cleveland Clinic

There isn’t an ideal way to cope with a life-threatening illness like hepatocellular carcinoma. But you can do things to help yourself and your loved ones through this difficult time. To feel more confident about your choices, take time to understand your treatment options and side effects. To feel less anxious, try meditation, deep breathing or gentle exercise. To avoid feeling isolated, share your experience with others going through the same thing — these conversations can help you and might help them.