Hepatocellular carcinoma
Alerts and Notices
Synopsis

Patients are typically asymptomatic in the early stages of the disease. In the United States, right upper quadrant abdominal pain, weight loss, and malaise are common presenting symptoms. Jaundice, ascites, and hepatosplenomegaly may occur in patients with bile duct obstruction. Late findings include portal hypertension, abdominal bleeding, encephalopathy, and liver failure.
The Barcelona Clinic Liver Cancer algorithm is widely used for HCC staging:
- Very early stage (0): Solitary nodules ≤ 2 cm. Treatment includes ablation or resection.
- Early stage (A): Solitary nodule > 2 cm OR 2-3 nodules all ≤ 3 cm. Treatment options include resection, transplantation, or ablation.
- Intermediate stage (B): > 3 nodules OR ≥ 2 nodules if any are > 3 cm. Treat with chemo-embolization.
- Advanced stage (C): Macrovascular invasion OR extrahepatic spread. Treat with systemic therapies.
- Terminal stage (D): End-stage liver function. Nontransplantable HCC. Supportive care.
Codes
ICD10CM:C22.0 – Liver cell carcinoma
SNOMEDCT:
25370001 – Hepatocellular carcinoma
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Hepatic adenoma – A benign lesion, generally uncommon but more common among women than men. Risk factors include long-term oral contraceptive use and estrogen exposure during pregnancy. Up to 30% of cases are complicated by bleeding.
- Dysplastic nodules from cirrhosis
- Fibrous nodular hyperplasia
- Cholangiocarcinoma
- Pyogenic liver abscess
- Metastatic cancer (colon / rectal, pancreatic, gastric) – distinguish with radiology and biopsy histology
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
Subscription Required
Last Reviewed:04/26/2018
Last Updated:01/31/2023
Last Updated:01/31/2023