Primary liver cancer encompasses hepatocellular carcinoma (HCC) and bile duct cancer (cholangiocarcinoma). Sometimes, cancer from other sites can spread to the liver (e.g colon cancer), in these cases, the liver is a secondary site of metastases (spread). The focus of this article will be adult hepatocellular carcinoma (HCC).
HCC is the most common primary liver cancer. It is the 5th most common cancer worldwide (1), and is the second leading cause of cancer related death (2).
The following are known risk factors for HCC:
Locally in Singapore, Hepatitis B is the most common risk factor for HCC. Patients who have hepatitis B or liver cirrhosis should have regular surveillance for the development of HCC.
How is HCC detected? what investigations may be ordered?
HCC may be detected as part of a surveillance regime (periodic assessment in individuals with an increased risk for HCC e.g. Hepatitis B or liver cirrhosis) or as part of the evaluation of symptoms. Your doctor as part of the evaluation, will take a history and perform a physical examination.
If you have Hepatitis B or liver cirrhosis, your doctor may order:
If a new suspicious lesion is seen on ultrasound, or if there is already a high suspicious of cancer your doctor may order:
HCC may be diagnosed by imaging criteria alone. Only in cases of uncertainty, may a liver biopsy which involves using a thin needle to obtain a sample of liver tissue to look for cancerous cells. In this context, it is usually done under imaging guidance.
If HCC that is detected, treatment options depends on: a) the size and whether there is evidence of spread, b) the severity of liver cirrhosis (if present) and c) the overall functional status.
Treatment options include:
In summary, HCC is the most common primary liver cancer. Patients who are at increased risk for HCC such as patients with Hepatitis B or Liver cirrhosis should undergo regular surveillance to detect HCC early. HCC is largely diagnosed by imaging (CT or MRI of the liver).
Once HCC is diagnosed, options for treatment depends on the size of the tumour or if there is spread, the health of the underlying liver (if there is cirrhosis), and the overall functional condition of the patient.
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