Hepatocellular Carcinoma

This chapter focuses on hepatocellular carcinoma (HCC), the most common primary liver cancer in adults. HCC typically arises in the context of chronic liver disease, such as hepatitis B or C infection, alcoholism, nonalcoholic steatohepatitis (NASH), or cirrhosis due to other causes. Risk factors for HCC include chronic hepatitis B and C infections, aflatoxin exposure, heavy alcohol consumption, and metabolic syndromes such as obesity and diabetes. Notably, hepatitis B vaccination programs have successfully reduced HCC incidence in high-risk regions. Diagnosis of HCC often involves imaging techniques such as ultrasound, CT, or MRI, which can detect characteristic features of the tumor. Alpha-fetoprotein (AFP) is a commonly used serum marker, although it is not specific for HCC. Biopsy may be required in certain cases to confirm the diagnosis. Staging of HCC is crucial for determining the appropriate treatment strategy. The Barcelona Clinic Liver Cancer (BCLC) staging system is widely used, incorporating tumor characteristics, liver function, and performance status to guide treatment decisions. Treatment options include surgical resection, liver transplantation, ablation therapies, transarterial chemoembolization (TACE), and systemic therapies such as sorafenib for advanced stages. Prognosis of HCC depends on the stage at diagnosis, underlying liver function, and the treatment modalities applied. Early detection and appropriate management are key to improving outcomes for patients with HCC.