Hepatocellular Carcinoma: 5 Things to Know

Managing patients who are at risk for or have been diagnosed with hepatocellular carcinoma (HCC), the most common form of liver cancer, can be daunting. Who should undergo surveillance and how? What is the next step once a liver lesion is identified? What treatment options can be offered?

Here are five things to know about HCC to help answer these difficult questions.

1. The most important risk factor for HCC is cirrhosis.

Cirrhosis precedes HCC in 80%-90% of patients, and one third of all patients with cirrhosis will develop HCC. The incidence of HCC is 1%-8% per year in all patients with cirrhosis (Table 1).

HCC surveillance is recommended for at-risk patient populations every 6 months, in line with the thresholds established by cost-effectiveness models. The rationale behind the frequency of imaging is that HCC has an average 6-month doubling time. For example, a 1-cm tumor not detected on ultrasound imaging will double in size to a 2-cm tumor in 6 months. Ultrasound will be more sensitive for detecting the tumor at this larger size, and the tumor will still be well within the size criteria for curative treatment options. Studies comparing surveillance intervals have also found 6 months to be optimal for improving survival.

Although not as common, HCC can occur without cirrhosis.