HCC arises from liver cells, generally in the background of cirrhosis (90% of cases). HBV or HCV infection is present in 80% of cases. The other causative factors are alcohol intake, cigarette smoking, aflatoxin consumption (a type of fungal toxin which contaminates food products) and diabetes. The obesity epidemic will be the most important causative factor in the near future.
The most important preventive measures are avoidance of viral infection or toxin intake. Vaccination against HBV will play a huge part in decreasing the incidence in high-risk areas. Health campaigns to raise awareness against alcohol and proper control in health care to prevent blood-borne infection will also be extremely important to prevent this disease.
Antiviral drugs against hepatitis B and C play a significant role in reducing the incidence of HCC in the long run.
To detect the disease at an early stage USG at 6 monthly intervals is recommended for patients with cirrhosis and any doubtful findings should be further evaluated with CT scan or MRI scan. HCC has typical features which can be detected with CT/MRI.
Treatment will depend upon the underlying liver status and tumor stage.
If background liver is normal (in about 10% of cases), resection of the tumor-bearing area of the liver will serve the purpose.
In the presence of cirrhosis, liver transplantation is the first-line treatment option. If transplantation is not feasible ethanol injection, radiofrequency ablation or microwave ablation can offer long term cure.
Beyond these modalities, TACE and Oral Sorafenib are the only treatment options available.
Cirrhotic patients should be under strict follow-up, preferably in transplant centers, for early detection and proper management of HCC.
Dr. Sanjay Goja, Director & Clinical Lead Liver transplant, HPB & Robotic Liver Surgery at Narayana Health