MRI Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, occurring predominantly in patients with underlying chronic liver disease and cirrhosis. It arises from hepatocytes, the liver’s main cell type, which makes up about 80% of the liver’s mass. Understanding HCC involves looking at its causes, symptoms, and available treatments.

Causes:

The development of HCC is typically linked to several risk factors:

• Chronic viral hepatitis: Hepatitis B and C are significant risk factors, with chronic infection leading to liver damage and increased cancer risk.
• Cirrhosis: Regardless of the cause, cirrhosis (scarring of the liver) enhances the risk of developing HCC.
• Alcohol consumption: Excessive alcohol intake can lead to alcoholic liver disease and cirrhosis, subsequently increasing HCC risk.
• Other Factors: These include hereditary diseases such as hemochromatosis, autoimmune hepatitis, and primary biliary cirrhosis, as well as lifestyle factors such as obesity and type 2 diabetes.

Symptoms:

HCC usually remains asymptomatic in its early stages and is often diagnosed incidentally during routine screening in patients with known risk factors. As the tumor grows, symptoms may include:

• Abdominal Pain: Particularly in the upper right part of the abdomen.
• Weight Loss: Unintentional and significant weight loss is common.
• Weakness and Fatigue: General feelings of being unwell.
• Jaundice: Yellowing of the skin and eyes due to liver dysfunction.
• Swelling: Accumulation of fluid in the abdomen (ascites) or swelling of the legs.
• Others: Loss of appetite, nausea, or vomiting.

Treatment:

The treatment of HCC depends on several factors, including the stage of the disease, liver function, overall health, and the presence of cirrhosis. Options include:

• Surgical Resection: Removal of the tumor is possible in patients with good liver function and a solitary tumor with no vascular invasion.
• Liver Transplantation: Suitable for patients with early-stage HCC who have significant liver dysfunction or cirrhosis.
• Targeted Therapy: Drugs such as sorafenib, lenvatinib, and others block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. These are generally used for advanced HCC.
• Immunotherapy: Treatments like nivolumab and pembrolizumab help the immune system recognize and attack cancer cells. These are options for patients who do not respond to targeted therapies.
• Radiation Therapy: Advanced techniques like stereotactic body radiation therapy (SBRT) can deliver high doses of radiation to the tumor with minimal impact on surrounding healthy tissues, used mainly when other treatments are not suitable.
• Chemotherapy: Less commonly used for HCC compared to other cancers, as it tends to be less effective. However, it may be used in certain circumstances
• Ablation therapies: Techniques like radiofrequency ablation or microwave ablation destroy the tumor without removing it.