Hepatocellular Carcinoma (HCC)

What is the liver?
The liver is the largest internal organ and has several important jobs, including:[1]

• Breaking down and storing nutrients from food (which people need to make energy and to grow).
• Making the chemicals or ‘factors’ that allow a person’s blood to clot if they cut themselves.
• Delivering bile into the intestines to help soak up fats from food.
• Breaking down alcohol, drugs and toxic chemicals in the blood.

In the liver, two-thirds of all cells are a type called ‘hepatocytes’,[2] but other cell types make up the liver’s many blood vessels and bile ducts (tubes that carry bile to the gallbladder or intestines).[3] Based on where, and in what type of cell, the cancer starts, different kinds of liver cancer can develop.[3] One of these is ‘hepatocellular carcinoma’ or HCC.

What is hepatocellular carcinoma or HCC?
Hepatocellular carcinoma or HCC is the most common type of liver cancer. It is more common in people who already have liver damage, either through a disease called cirrhosis or other conditions.[3]

HCC begins in liver cells called ‘hepatocytes’.[4] Under healthy conditions hepatocytes can carefully control their own growth and will die if they become injured or cannot work properly, just like other normal cells.[5] HCC can begin when changes happen in the genes within the hepatocytes, the instructions that tell the cells how to behave. These changes can lead to uncontrolled cell growth and a tumour starting to grow.[6]

What are the risk factors for hepatocellular carcinoma?
It is not fully understood what leads to the development of hepatocellular carcinoma, but there are some circumstances that can increase a person’s chances of getting the disease, called ‘risk factors’. Some risk factors are:[7]

• Cirrhosis – liver scarring because of previous damage. Cirrhosis can be caused by infection with a virus like hepatitis B or C, or by drinking alcohol regularly (drinking alcohol might also damage the genes in liver cells). This scarring can cause problems with the way the liver works.
• Smoking.
• Non-alcoholic fatty liver disease – this is a condition where fatty build-ups in the liver may cause swelling and, in time, cirrhosis.

What are the symptoms of hepatocellular carcinoma?
Hepatocellular carcinoma or HCC does not usually cause symptoms in the early stages of the disease, but if symptoms happen, they may include weight loss, yellowing of the skin and whites of the eyes called ‘jaundice’, and a swollen or painful belly.[8]

How is hepatocellular carcinoma diagnosed?
If a person is at a high risk of getting hepatocellular carcinoma, possibly because they have one or more of the risk factors listed above, they might go through ‘routine screening’. This can help doctors detect HCC as early as possible.[9]

A number of methods can be used to diagnose HCC. These include blood tests to measure how well the liver is working[10] and ultrasound, CT or MRI scans to get an image of the liver.[11] The doctor may also want to do a ‘biopsy’, which means taking a small sample of liver tissue, to make sure the diagnosis is correct.[10]

What is advanced hepatocellular carcinoma?
When hepatocellular carcinoma or HCC is diagnosed, it is given a stage based on how much it has grown within the liver or spread to other parts of the body. This can be ‘early,’ ‘intermediate’, or ‘advanced’.

HCC is called advanced when it has spread to a part of the immune system called ‘lymph nodes’ or to other organs.[12] Advanced HCC is not usually treated with surgery,[13] but the doctor will be able to advise on other treatment options.

What treatment options are available for advanced hepatocellular carcinoma?
One possibility is to use drugs that block the messages telling the cells to grow:[14] those drugs, called ‘TKIs’, are the preferred treatment option (known as the ‘standard-of-care’) for advanced hepatocellular carcinoma.[12] Current research is looking at ‘cancer immunotherapy’ or CIT. CIT works by helping the immune system to find and attack cancer cells.[15] Clinical trials are ongoing to look into CIT as first treatment of HCC for several CIT drugs.