NeoExplorer
Hepatocellular Adenocarncinoma
Hepatocellular adenocarcinoma (HCC) is the most common primary malignant tumour of the liver. Its most noticeable features are its very poor prognosis, and its considerable amount of geographic variation. It is highly associated with chronic hepatitis B or chronic hepatitis C, and non-alcoholic fatty liver disease (NAFLD). [1] [2]
Epidemiology
HCC is the most common primary malignant tumour of the liver, and possibly the most common malignant tumour world-wide.
HCC is the most common cause of death of those who experience cirrhosis. Cirrhosis is the end stage of liver disease in which scarring has resulted in chronic liver failure and permanent damage. [2]
There is a lot of geographic variation in HCC patients, with countries in South-East Asia and tropical Africa having the highest incidences. The lowest incidence is in Western countries [1].
Etiology
There are four common causes of HCC:
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Viral hepatitis
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non-alcoholic fatty liver disease (NAFLD)
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Alcohol
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Aflatoxins
The most common cause is viral hepatitis, with chronic hepatitis B and chronic hepatitis C associating with 70% of cases of HCC. [1]
Viral Hepatitis
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Hepatitis B affects over 250 million individuals worldwide
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Hepatitis B is the most common cause of hepatitis
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Hepatitis leads to subsequent fibrosis, necrosis and regeneration of liver tissue cells [1]
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Hepatitis C is well known for contributing to HCC development through chronic inflammation [4]
Non-Alcoholic Fatty Liver Disease (NAFLD)
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NAFLD is defined as excess fat in hepatocytes (liver cells) that is not due to the consumption of alcohol
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this is most commonly associated with a metabolic complications
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e.g. insulin resistance, hypertension, hypertriglyeridema, and obesity
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more commonly causes HCC in Western countries with fat-heavy diets
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expected to increase in incidence due to increased incidence of obesity [5]
Alcohol
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30% of HCC is related to history of excessive alcohol ingestion in the US
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can directly and indirectly cause HCC
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can indirectly cause HCC through cirrhosis
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can directly lead to HCC through increased oxidative stress and inflammation [6]
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Aflatoxins
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Mycotoxin is produced by fungus and is mostly found in Southeast Asia and Africa [7]
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fungus commonly infects grains
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the cancer causing factor is likely the mutation of the tumour suppressor gene p53 [7]
Gross Anatomy
This image shows the catastrophic effects of hepatocellular adenocarcinoma. This aggregation of malignant hepatocytes creates a mass that severely damages liver function.
Features are dependant on the differentiation of the hepatocytes, tumours of HCC can range from well-differentiated to poorly differentiated [1].
[8]
Risk Factors
The two main risk factors are any activities that lead to cirrhosis, like overuse of drugs and toxins, and chronic viral hepatitis.
Preventative measures of good hygiene and avoidance of drug use can be taken. [1] [2]
(3)
Signs and Symptoms
Patients can present without symptoms or with symptoms at the time of cancer detection such as:
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abdominal pain
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nausea
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jaundice
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vomiting
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unintentional weight loss
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easy bruising from blood clotting abnormalities [1] [2]
Diagnosis
There are four different ways HCC can be confirmed.
Biochemistry of liver function tests
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alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and albumin may be elevated
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can indicate the severity of the disease
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hepatitis B surface antigen, anti-HCV antibody, alph anti-trypsin level, copper levels and iron saturation can indicate etiology [1]
Serum alpha-fetoprotein (AFP)
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serum glycoprotein produced by fetal yolk sac and fetal liver during gestation
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elevated serum levels are typical for advanced HCC [12]
Imaging:
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ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) [1]
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can determine the size, morphology, location and vascular invasion of HCC [13]
Liver biopsy:
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has a sensitivity rate of 66%-93% depending on the size of the tumour
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not routinely done for HCC as it can cause more damage
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can also result in false negatives if tissue is not extracted from the appropriate site [14]
Prognosis
HCC is well known for having a very poor prognosis secondary only to pancreatic cancer. The five year survival rate is 18%. Most patients die within weeks to months of diagnosis. [15] Prognosis is dependant on:
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tumour size
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differentiation of grade of the tumour
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severity of underlying disease
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presence or absense of metastasis
Patients with HCC caused by underlying hepatitis B are associated with a poorer prognosis and higher recurrence. [16]
Treatment
There are five common treatment options for HCC; treatment plans are contingent on the degree of cancer progression.
Surgical resection
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ideal for very early stages of cancer with little metastasis
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preserves liver function as it only removes a portion of the liver [9]
Liver transplantation
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associated with the potential of curing the cancer
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removal of all tumours [10]
Tumour ablation
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prescribed for those in early stages of HCC
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for those that do not meet surgical resection criteria
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uses heat, cold or chemicals to fight cancer [11]
Trans-arterial therapies
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considered for patients with an intermediate stage of cancer
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minimally invasive
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deliver drugs directly to blood vessels supplying the tumour [1]
Systemic chemotherapy
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for those with advanced stages and or systemic spread
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last resource method [1]
Image credits
Images generated for this website are curtesy of ChatGPT.
“ChatGPT - Alcohol Clipart Request.” ChatGPT, 2025, chatgpt.com/share/67f01f00-d4e8-8012-9390-2167c496c7f8. Accessed 4 Apr. 2025.
“ChatGPT - Illustration of Human Liver.” ChatGPT, 2025, chatgpt.com/share/67f01fd0-308c-8004-87c1-c1570ec80c93. Accessed 4 Apr. 2025.