Hepatocellular Carcinoma Symptoms

Hepatocellular Carcinoma – Symptoms

Hepatocellular carcinoma, (HCC), is a primary malignancy of the liver and the third leading cause of cancer death worldwide. It occurs predominantly in patients with chronic liver disease and cirrhosis. Tumors may present as a single mass lesion or as diffuse growth, which can be difficult to differentiate from the surrounding cirrhotic liver tissue. Hepatitis B and hepatitis C strongly influence the development of chronic liver disease and subsequent development of HCC. A comprehensive history that includes alcohol and drug use is key.

Physical symptoms of hepatocellular carcinoma may be difficult to assess in an early stage. The presentation may be caused in part by tumor or tumors mass effect or the obstruction of the biliary system and the liver vasculature. Many other gastrointestinal diseases can mimic the same symptoms. As the cancer grows, one or more of these may be seen:

• Pain in the upper right abdomen

• A lump or feeling of heaviness in the epigastrium

• Ascites or abdominal swelling

• Loss of appetite and feelings of fullness

• Weight loss

• Weakness or deep fatigue

• Nausea and vomiting

• Jaundice of  sclera and skin

• Pale, chalky bowel movements and dark urine

• Fever

• Pallor

• Itchy or dry skin

• Swelling of the lower extremities

Due the nonspecific nature of some of these physical symptoms, the diagnosis of HCC need to be made based on the additional testing. Laboratory evaluation for signs of advanced liver disease may assist in the diagnosis. HCC is now increasingly recognized at a much earlier stage due to the routine screening of patients with known cirrhosis due to alcohol or hepatitis. Serum alpha-fetoprotein (AFP) measurements that are elevated are a significant sign of liver cancers. Levels higher than 400ng/ml are considered diagnostic. Also, thrombocytopenia, with a platelet count below 100,000/μL is highly suggestive of significant portal hypertension/splenomegaly.

As the disease progresses patients frequently show symptoms of hepatic encephalopathy. As the failing liver is unable to clear toxins, confusion and combativeness and subsequent coma develop. The patient may also develop esophageal varices and bleeding tendencies. Without aggressive surgical resection, ablative therapy, or liver transplantation, HCC results in liver failure and eventual death.

References:

Cicalese, Luca. (2018). Hepatocellular Carcinoma. Medscape. Retrieved from https://emedicine.medscape.com/article/197319-overview.