Hepatocellular carcinoma
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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
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Hepatic adenoma
- 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
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Management Pearls
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Therapy
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References
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Last Reviewed:04/27/2018
Last Updated:05/20/2020
Last Updated:05/20/2020