Hepatoma, or hepatocellular carcinoma (HCC), is the most common type of primary liver cancer. Primary cancer originates in the liver’s cells (hepatocytes), distinguishing it from secondary cancer that spreads to the liver from another part of the body. Hepatoma develops almost exclusively in individuals with pre-existing liver damage, making liver health a central factor in its development.
Underlying Causes and Major Risk Factors
Hepatocellular carcinoma arises from long-term liver damage and inflammation. Chronic viral infections are a predominant cause, with hepatitis B (HBV) and hepatitis C (HCV) responsible for most cases globally. These viruses can alter the DNA of liver cells, promoting mutations that lead to uncontrolled cell growth. Chronic HBV infection is a cause of HCC even without advanced liver scarring, known as cirrhosis.
Cirrhosis from long-term, heavy alcohol consumption is another contributor to the chronic liver disease that precedes hepatoma. Alcohol increases cancer risk, especially in individuals with viral hepatitis. The metabolism of alcohol produces toxic byproducts that cause inflammation and damage liver cell DNA over time.
A growing cause of liver damage is non-alcoholic fatty liver disease (NAFLD), linked to obesity, metabolic syndrome, and type 2 diabetes. Its more severe form, non-alcoholic steatohepatitis (NASH), involves fat accumulation with inflammation that can progress to cirrhosis and hepatoma. HCC can also develop in individuals with NAFLD even before cirrhosis is present.
Other risk factors contribute to hepatoma development. Exposure to aflatoxins, toxic compounds from molds on crops like corn and peanuts, is a cause in parts of Asia and Africa. Inherited metabolic disorders like hemochromatosis (iron overload) and Wilson’s disease (copper overload) also increase risk by causing chronic liver injury.
Recognizing Symptoms and Diagnostic Process
Early-stage hepatoma is often asymptomatic, which is why it is frequently discovered at a more advanced stage. As a tumor grows, it can cause non-specific symptoms. These include unexplained weight loss, a loss of appetite or feeling of fullness, and pain in the upper right abdomen.
As the cancer progresses and liver function worsens, more distinct symptoms can appear. Jaundice, a yellowing of the skin and eyes, may occur if the liver cannot process bilirubin. Other symptoms include abdominal swelling from fluid buildup (ascites), persistent itching, or fever.
The diagnostic process begins with routine screening for high-risk patients or when symptoms appear. Initial tests include blood work to assess liver function and measure alpha-fetoprotein (AFP). An elevated AFP level can be a sign of hepatoma, but it is not always a definitive marker and can be raised by other liver conditions.
If cancer is suspected, imaging tests are used to visualize the liver. An ultrasound is often the first step, followed by more detailed multiphase computed tomography (CT) or magnetic resonance imaging (MRI) scans. These advanced scans use contrast dye to highlight the tumor’s unique blood flow pattern, which helps in identification.
A diagnosis can often be made from these imaging results and AFP levels without a liver biopsy. A biopsy, which involves removing a small tissue sample for examination, is the most definitive method but is reserved for cases where the diagnosis is uncertain.
Determining the Stage of Hepatoma
Once hepatoma is diagnosed, the cancer is staged to guide treatment decisions. Staging assesses the tumor’s characteristics and the patient’s overall condition. This evaluation considers the size and number of tumors, whether the cancer has invaded nearby blood vessels, and if it has metastasized to other parts of the body.
Staging also assesses the patient’s underlying liver function and overall physical health, or performance status. Since hepatoma develops in a damaged liver, the organ’s remaining function is a major factor in determining prognosis and treatment tolerance. Liver function is assessed using scoring systems like the Child-Pugh score.
The most widely used classification system is the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC system categorizes patients into one of five stages, from very early (Stage 0) to terminal (Stage D). Each stage is linked to specific treatment recommendations, making it a primary tool for creating a treatment plan.
Primary Treatment Modalities
Hepatoma therapies are categorized by their goal, from curative treatments for early-stage disease to palliative care for advanced cancer. For patients with early-stage tumors confined to the liver, curative options are considered. These include surgical resection to remove the part of the liver with the tumor, and liver transplantation, which replaces the diseased liver with a healthy donor organ.
When surgery is not an option, locoregional therapies that target the tumor directly within the liver are used. Ablation techniques, like radiofrequency ablation (RFA) or microwave ablation (MWA), use heat to destroy cancer cells. These methods are effective for smaller tumors.
For larger or multiple tumors confined to the liver (intermediate-stage), transarterial chemoembolization (TACE) is a common treatment. This procedure injects chemotherapy drugs into the artery supplying the tumor and then blocks that artery. This action cuts off the tumor’s blood supply while delivering concentrated medication.
For advanced hepatoma that has spread to blood vessels or other parts of the body, systemic therapies are the primary treatment. These drugs travel through the bloodstream to reach cancer cells anywhere in the body. Targeted therapy drugs disrupt specific pathways that allow cancer cells to grow, while immunotherapy harnesses the body’s immune system to attack the cancer.
Prognosis and Long-Term Management
The prognosis for hepatoma depends on the stage at detection and the patient’s underlying liver health. Early detection improves the outlook because it allows for curative treatments like surgery or transplantation. Patients with well-preserved liver function have a better prognosis and can tolerate more aggressive therapies.
After treatment, long-term management focuses on surveillance for cancer recurrence. Hepatoma has a high recurrence rate, either from the original tumor or a new one developing in the damaged liver. Patients undergo regular follow-up with imaging scans (CT or MRI) and blood tests to monitor AFP levels, allowing for early detection of new tumors.
Managing the underlying chronic liver disease is a fundamental part of long-term care. This involves continuing antiviral therapy for viral hepatitis or making lifestyle changes for alcohol-related disease or NAFLD. These steps help preserve remaining liver function and reduce the risk of future cancer.