Hepatocellular carcinoma is one of the most common malignancies worldwide, with over 1 million new cases annually. Risk factors include cirrhosis from hepatitis B or C, alcohol consumption, and non-alcoholic steatohepatitis. Symptoms vary and include abdominal pain, weight loss, jaundice, and cirrhosis symptoms. Staging systems include Okuda and CLIP classifications which consider tumor extent, ascites, bilirubin and albumin levels, and portal vein thrombosis. Treatment depends on staging and liver function but may include surgical resection, ablation, transarterial chemoembolization, radiation, chemotherapy, or liver transplant. Early stage 1-2 HCC is typically treated

1. Hepatocellular Carcinoma
Dr Shatdal Chaudhary

2. Incidence
• One of most common malignancy world wide
• Annual 1 million case
• M:F 4:1
• Mean Age 56 ± 13
• Associated with
– cirrhosis 81%
– No cirrhosis 19%

3. • Etiology
– Cirrhosis from any cause
– Hep B&C chronic infection
– Chronic ethanol consumption
– NASH/NAFLD
– Mycotoxin- Alfatoxin B1

4. • Unusual
– Pri biliay cirrhosis
– Hemachromatosis
– Α1 Antitrypsin def
– Glycogen storage disorder
– Wilson disease

5. C/F
• Symptoms (%)
– Abdominal pain 40
– Weight loss 24
– Appetite loss 11
– Weakness 15
– Jaundice 5
– Cirrhosis Symptoms 18
– No Symptoms 24

6. Physical Signs
• Hepatomegaly 50-90%
• Ascites 30-60%
• Splenomegaly
• Abdominal bruit
• Fever 10-50%
• Signs of cirrhosis

7. • Paraneoplastic syndromes
– Hypoglycemis
– Erytherocytosis
– Hypercalcemia
– Hypercholesterolemia
– Dysfibrogenemia
– Carcinoid synd
– Chage in sexual characteristic

8. Staging
• Okuda Classification + -
– Tumor extent ≥50% <50%
– Ascites + -
– Albumin ≤3(g/L) >3
– Bilirubin ≥3 <3
• Stage 1 all-
• Stage 2 1/2 +
• Stage 3 3/4 +

9. CLIP staging
• 0 1 2
• Tumor number single multiple -
• Tumor extent <50 <50 >50
• Child Pugh score A B C
• AFP <400 >400 -
• Portal vein thromb No Yes -
• CLIP 0, CLIP1, CLIP2, CLIP3.

10. Investigation
• USG- Liver mass with hyper vascularity
Portal vein thrombosis
• Helical CT Scan
• Serological assay
– AFP 50%
– AFP-L3 80%
– DCP/PIVKA-2
• USG guided Core Liver Biopsy/FNAC

11. Treatment
Treatment option
• Surgery: Resection/ Liver Transplant
• Local Ablative therapies
– Cryosurgery
– Radiofrequency Ablation
– Percutaneous ethanol injection

12. • Regional Therapies
– Transarterial chemotherapy
– Transarterial embolization
– Transarterial chemoembolization
– Transarterial radiotherapy
• Conformal External-Beam radiation
• Chemotherapy
• Immunotherapy

13. Stages 1 and 2 HCC
• Surgical resection/RFA/ Local injection
– Child A, Noncirrhotic, No Metastasis, Single lesion
– Child B, C – Orthotopic liver trasplant
– Percutaneous ethanol injection

14. Stages 3 and 4
• Poor prognosis
• If no meastasis – transplant
• Chemotherapy
– Doxorubicin
– Cisplatin
– Mitomycin C
– Oral Sorefenib