Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Causes

Doctors aren’t sure exactly what causes all cases of hepatocellular carcinoma, but they’ve identified some things that may increase your risk for getting it:

Hepatitis B or hepatitis C. Hepatocellular cancer can start many years after you’ve had one of these liver infections. Both are passed through blood, such as when drug users share needles. Blood tests can show whether you have hepatitis B or C.

Cirrhosis. This serious disease happens when liver cells are damaged and replaced with scar tissue. Many things can cause it: hepatitis B or C infection, alcohol drinking, certain drugs, and too much iron stored in the liver.

Heavy drinking. Having more than two alcoholic drinks a day for many years raises your risk of hepatocellular cancer. The more you drink, the higher your risk.

Obesity and diabetes. Both conditions raise your risk of liver cancer. Obesity can lead to nonalcoholic fatty liver disease, which can lead to hepatocellular carcinoma. The higher risk from diabetes may be due to liver damage caused by the disease. Plus, people with diabetes are often overweight or obese.

Anabolic steroids. Drugs that mimic the male sex hormone testosterone are sometimes used by athletes to build muscle mass. Long-term use increases your risk.

Iron storage disease. This causes too much iron to be stored in the liver and other organs. People who have it may develop hepatocellular carcinoma.

Aflatoxin. This harmful substance, which is made by certain types of mold on peanuts, corn, and other nuts and grains, can cause hepatocellular carcinoma. The U.S. has safety measures that limit aflatoxin in the food supply.

Symptoms

You might not have any symptoms when hepatocellular carcinoma is in an early stage. As the cancer grows, you may have one or more of these:

• Pain in the upper right part of your belly
• A lump or feeling of heaviness in your upper belly
• Bloating or swelling in your belly
• Loss of appetite and feelings of fullness
• Weight loss
• Weakness or deep fatigue
• Nausea and vomiting
• Yellow skin and eyes
• Pale, chalky bowel movements and dark urine
• Fever

Diagnosis

Tests and procedures used to diagnose hepatocellular carcinoma include:

• Blood tests to measure liver function
• Imaging tests, such as CT and MRI
• Liver biopsy, in some cases, to remove a sample of liver tissue for laboratory testing

Treatment

Which treatment is best for you will depend on the size and location of your hepatocellular carcinoma, how well your liver is functioning, and your overall health.

Hepatocellular carcinoma treatments include:

• Surgery. Surgery to remove the cancer and a margin of healthy tissue that surrounds it may be an option for people with early-stage liver cancers who have normal liver function.
• Liver transplant surgery. Surgery to remove the entire liver and replace it with a liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.
• Destroying cancer cells with heat or cold. Ablation procedures to kill the cancer cells in the liver using extreme heat or cold may be recommended for people who can’t undergo surgery. These procedures include radiofrequency ablation, cryoablation, and ablation using alcohol or microwaves.
• Delivering chemotherapy or radiation directly to cancer cells. Using a catheter that’s passed through your blood vessels and into your liver, doctors can deliver chemotherapy drugs (chemoembolization) or tiny glass spheres containing radiation (radioembolization) directly to the cancer cells.
• Radiation therapy. Radiation therapy using energy from X-rays or protons may be recommended if surgery isn’t an option. A specialized type of radiation therapy, called stereotactic body radiotherapy (SBRT), involves focusing many beams of radiation simultaneously at one point in your body.
• Targeted drug therapy. Targeted drugs attack specific weaknesses in the cancer cells, and they may help slow the progression of the disease in people with advanced liver cancers.
• Immunotherapy. Immunotherapy drugs use your body’s germ-fighting immune system to attack the cancer cells. Immunotherapy may be an option for treating advanced liver cancer.
• Clinical trials. Clinical trials give you a chance to try new liver cancer treatments. Ask your doctor whether you’re eligible to participate in a clinical trial.

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