Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, originating in the main cells of the liver. While early-stage HCC can often be treated with curative intent, “advanced” signifies a stage where the cancer has progressed significantly. This typically means the cancer has spread beyond the liver to other parts of the body, a process known as metastasis, or it has grown extensively within the liver itself, making surgical removal or local treatments challenging or impossible. Understanding this distinction is important.
Characteristics of Advanced Hepatocellular Carcinoma
Advanced HCC broadly corresponds to later stages of disease classification systems, such as stages C and D within the Barcelona Clinic Liver Cancer (BCLC) staging system. These stages indicate tumor invasion into blood vessels, spread to lymph nodes, or distant metastasis. Systemic symptoms, tumor burden, and liver function also help define these advanced stages.
Individuals with advanced HCC experience symptoms due to the cancer’s progression and impact on liver function. Common symptoms include abdominal pain and abdominal swelling due to fluid retention, known as ascites. Other signs include unexplained weight loss, fatigue, and jaundice, which presents as yellowing of the skin and eyes. Nausea, loss of appetite, and a feeling of fullness after eating small amounts are also reported.
Diagnosis of advanced HCC involves a combination of imaging techniques and blood tests. Imaging studies like computed tomography (CT) scans and magnetic resonance imaging (MRI) are used to visualize the liver, identify tumors, and assess their size, location, and spread. These scans use contrast agents to highlight tumor characteristics. Blood tests, including alpha-fetoprotein (AFP) levels, can also indicate HCC, though elevated AFP can occur in other liver conditions. While imaging and AFP levels often suggest a diagnosis in high-risk patients, a liver biopsy may be performed to confirm cancer cells, especially when imaging results are inconclusive or for treatment planning.
Treatment Options for Advanced HCC
Treatment for advanced HCC primarily focuses on systemic therapies, which work throughout the body to target cancer cells. These treatments aim to slow disease progression, alleviate symptoms, and improve an individual’s quality of life and survival. The selection of therapy depends on various factors, including the extent of the cancer, liver function, and overall health.
Targeted therapies are a category of treatment that interferes with specific molecules involved in cancer growth and progression. Multikinase inhibitors, such as sorafenib, are examples. Sorafenib, taken as a tablet, blocks chemical signals that promote cancer cell division and growth, and also inhibits the formation of new blood vessels that tumors need to survive. Other targeted therapies may also be used depending on tumor characteristics.
Immunotherapies are also treatment options for advanced HCC. These drugs, often called checkpoint inhibitors, enhance the body’s immune system to recognize and attack cancer cells. Atezolizumab, for instance, blocks a protein that cancer cells produce, which normally prevents the immune system from attacking them. This allows the immune system to more effectively fight the cancer.
Combination therapies are used, combining different types of drugs for a more comprehensive anti-cancer effect. For example, atezolizumab can be combined with bevacizumab. Bevacizumab prevents cancers from developing new blood vessels, cutting off their supply of nutrients and oxygen. This combination approach leverages different mechanisms to combat the disease.
In some cases, palliative radiation therapy may be considered to manage specific symptoms, such as pain caused by tumor growth in certain areas. This therapy aims to provide comfort rather than cure the cancer. Beyond established treatments, clinical trials offer opportunities for patients to access novel therapies that are still under investigation. These trials explore new drugs or combinations, contributing to advancements in advanced HCC treatment.
Prognosis and Support for Advanced HCC
The outlook for individuals diagnosed with advanced HCC can vary. Prognosis is influenced by several factors, including the extent of the cancer, the individual’s underlying liver function, and how well they respond to treatment. While advanced HCC generally carries a guarded prognosis, advancements in systemic therapies have provided new avenues for managing the disease.
Supportive care, also known as palliative care, plays a role in managing advanced HCC. This type of care focuses on alleviating symptoms, improving comfort, and enhancing the quality of life for patients and their families. It addresses needs including physical symptoms like pain, fatigue, and nausea, as well as emotional and psychological distress.
Palliative care teams include doctors, nurses, social workers, and other specialists who provide support. They help manage treatment side effects and address the emotional burden of living with a serious illness. Access to psychological support services and patient support groups can also offer coping strategies and a sense of community for individuals and their loved ones.