Oncology
Hepatocellular Carcinoma
간세포암
Hepatocyte-origin malignancy arising in chronic hepatitis/cirrhosis
- How common
- Common in Korea (90% of liver cancers)
- Typical age
- Ages 50–70 (M:F 3:1)
What is it?
Chronic injury (HBV/HCV/MASH/alcohol) causes cirrhosis, on which HCC develops.
Commonly affected: Liver (cirrhotic in 80%), portal vein, lung, bone
How it develops
- Chronic liver injuryHBV, HCV, alcohol, MASH cause sustained inflammation
- Cirrhosis & regenerative nodulesFibrosis with regenerative nodule formation
- Dysplastic nodule → HCCTERT, β-catenin, TP53 mutations accumulate
- Vascular invasion & metastasisPortal vein invasion, lung/bone/adrenal mets
Symptoms
- Tumor ruptureAcute pain and shock from rupture
- RUQ pain/massRUQ dull pain, palpable mass
- DecompensationJaundice, ascites, encephalopathy
- Weight loss/anorexiaAdvanced disease sign
- ParaneoplasticHypoglycemia, erythrocytosis, hypercalcemia
How it is examined
- Liver palpationHepatomegaly, nodular liver, splenomegaly
- Stigmata of cirrhosisSpider angiomas, palmar erythema, ascites
- Child-Pugh, ALBI scoreLiver function central to treatment decisions
Imaging
AXR nonspecific; CXR for lung mets.
- Elevated R hemidiaphragm
- Pulmonary nodules
4-phase CT or MRI: arterial enhancement + portal venous washout = LI-RADS 5 diagnosis. AFP supportive.
- Arterial enhancement
- Portal venous washout
- Capsule enhancement
Non-surgical care
- BCLC stage + Child-Pugh0/A: curative, B: TACE, C: systemic, D: BSC
- TACEBCLC B standard; embolize tumor-feeding artery
- Percutaneous ablation (RFA/MWA)Comparable to surgery for solitary <3cm
- Systemic (Atezo + Bev)Advanced 1st-line: atezolizumab + bevacizumab (IMbrave150)
- 2nd-line TKIsLenvatinib, sorafenib, regorafenib, cabozantinib
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
BCLC 0/A, preserved liver function (Child A), resectable
Procedures that may be discussed
- Anatomical hepatic resection (segment/sector)
- Liver transplantation (Milan: solitary <5cm or ≤3 nodules <3cm)
- Percutaneous RFA (<3cm)
- Y-90 radioembolization
Outlook
5-yr survival: 0/A 60–80%, B 30%, C 10–15%. Post-transplant 5-yr 70%.