Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Hepatocellular Carcinoma

(Hepatoma)

By

Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Aug 2021| Content last modified Aug 2021
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

Hepatocellular carcinoma is a cancer that begins in the liver cells and is the most common of the primary liver cancers.

Having hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. In the United States, over 1 million people have... read more Hemochromatosis (a hereditary disorder that causes the body to absorb too much iron) also increases the risk of developing hepatocellular cancer. Iron may accumulate in the liver and damage it.

Hepatocellular carcinoma sometimes results from exposure to certain cancer-causing substances (carcinogens). In subtropical regions where hepatocellular carcinoma is common, food is often contaminated by carcinogens called aflatoxins, substances that are produced by certain types of fungi.

Symptoms of Hepatocellular Carcinoma

Usually, the first symptoms are abdominal pain, weight loss, and a large mass that can be felt in the upper right part of the abdomen. People who have had cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more Cirrhosis of the Liver for a long time may unexpectedly become much more ill. A fever may occur. Occasionally, the first symptoms are sudden abdominal pain and shock (dangerously low blood pressure) caused by rupture or bleeding of the cancer.

Diagnosis of Hepatocellular Carcinoma

  • Physical examination

  • Blood and imaging tests

Detecting hepatocellular carcinoma early is difficult because at first, the symptoms do not provide many clues. If a doctor feels an enlarged liver or if an imaging test detects a mass in the upper right part of the abdomen during an examination done for other purposes, the doctor may suspect this cancer, especially in people with long-standing cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more Cirrhosis of the Liver . However, screening programs often enable doctors to detect this cancer before symptoms develop.

If hepatocellular carcinoma is suspected, the following are done:

If the diagnosis is still unclear, a liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more (removal of a small sample of liver tissue with a needle for examination under a microscope) can confirm the diagnosis. To improve the chances of obtaining cancerous tissue, doctors often use ultrasonography or CT to guide the placement of the biopsy needle. The risk of bleeding or other injury during a liver biopsy is usually low.

Staging

If cancer is diagnosed, doctors determine how large the cancer is and whether it has spread to nearby structures or other parts of the body. The imaging tests used for diagnosis can provide some of this information.

The cancer is classified ranging from stage I (a single tumor that has not spread) to stage IV (spread to distant parts of the body). Staging helps doctors decide on treatment and estimate survival.

Screening

Prognosis of Hepatocellular Carcinoma

Most people with hepatocellular carcinoma do not live for more than a few years because the cancer is detected at a late stage. Screening and early detection result in a better prognosis. If the cancer is small and has not spread and liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more can be done, the person can often live a number of years.

Prevention of Hepatocellular Carcinoma

Use of the vaccine against hepatitis B virus Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications (chronic hepatitis, cirrhosis, and liver cancer). Generally, hepatitis B is more serious than hepatitis A and... read more eventually reduces the incidence of hepatocellular carcinoma, especially in areas where the virus is common. Preventing the development of cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more Cirrhosis of the Liver regardless of cause can also help. For example, treating chronic hepatitis B Hepatitis B, Chronic Chronic hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that has lasted more than 6 months. Most people with chronic hepatitis B have no symptoms, but some... read more , chronic hepatitis C Hepatitis C, Chronic Chronic hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that has lasted more than 6 months. Hepatitis C often causes no symptoms until after it has badly... read more , fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. In the United States, over 1 million people have... read more Hemochromatosis and treating or preventing alcohol-related liver disease Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more Alcohol-Related Liver Disease can help prevent the cancer from developing.

Treatment of Hepatocellular Carcinoma

  • Surgery or liver transplantation

  • Radiofrequency ablation, chemoembolization, or internal radiation therapy

  • Chemotherapy and immunotherapy

Only liver transplantation or surgical removal of the cancer offers any hope of cure. However, when the cancer is surgically removed, it often recurs. Also, removing the cancer in people who have cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more Cirrhosis of the Liver may not be possible because too much of their liver is damaged.

When transplantation or surgery is not possible or when people are waiting for a liver transplant, treatments that focus on the tumor and areas around it can be used. These treatments may help slow the cancer's growth and relieve symptoms. For example, doctors may inject a chemical that destroys cancer cells into blood vessels to the cancer. Or they may use treatments that apply energy to cancer cells and thus destroy them. Three such treatments are

  • Radiofrequency ablation (which uses electrical energy)

  • Chemoembolization (which uses chemotherapy)

  • Selective internal radiation therapy (which uses radiation)

However, these treatments do not destroy all the cancer cells.

Chemotherapy drugs can be injected into a blood vessel that supplies a tumor (called chemoembolization). For example, drugs can be injected into a vein or into the hepatic artery. Injecting chemotherapy drugs directly into the hepatic artery delivers a large amount of the drugs directly to the cancer cells in the liver. The chemotherapy drug sorafenib is effective against hepatocellular carcinoma. Other chemotherapy drugs (for example, lenvatinib and regorafenib) and immunotherapy drugs (for example, nivolumab) are now being used in some people with this cancer.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American Cancer Society: Provides comprehensive information about liver cancer, including its symptoms, diagnosis, staging, and survival rates.

  • American Liver Foundation: Hosts community education programs that give an overview of all aspects of liver disease and wellness. Also provides access to support groups, information on finding a physician, and opportunities to participate in clinical trials.

NOTE: This is the Consumer Version. DOCTORS: CLICK HERE FOR THE PROFESSONAL VERSION
CLICK HERE FOR THE PROFESSONAL VERSION
Others also read
Test your knowledge
Liver Failure
Liver failure is a condition that occurs when a large portion of the liver becomes damaged and unable to function. Sometimes liver failure develops quickly, over several days (acute liver failure); other times, it develops slowly, over months or years (chronic liver failure). There are numerous causes of liver failure. Which of the following is NOT a common cause of liver failure?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP