What Is the Survival Rate for Hepatocellular Carcinoma?

Hepatocellular carcinoma is the most common form of liver cancer in adults. Liver cancer occurs when cells in the liver grow out of control.

What Are the Symptoms of Hepatocellular Carcinoma?

Symptoms of hepatocellular carcinoma may not occur until the later stages of the disease. 

When symptoms of hepatocellular carcinoma occur, they may include: 

• Weight loss without trying
• Loss of appetite
• Feeling of fullness after a small meal
• Nausea 
• Vomiting
• Enlarged liver, felt as fullness under the ribs on the right side
• Enlarged spleen, felt as fullness under the ribs on the left side
• Pain in the abdomen 
• Pain near the right shoulder blade
• Swelling or fluid build-up in the abdomen 
• Itching
• Yellowing of the skin and eyes (jaundice)
• Fever
• Enlarged veins on the abdomen that can be seen through the skin
• Abnormal bruising or bleeding

Hepatocellular carcinoma is believed to be caused by genetic changes (mutations), however, the exact cause for these mutations is unknown. 

Risk factors for developing hepatocellular carcinoma include: 

• Gender: much more common in men than in women
• Race/ethnicity: In the U.S., Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanics/Latinos, American Indians/Alaska Natives, African Americans, and whites
• Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)
• Cirrhosis 
  • Non-alcoholic fatty liver disease
  • Primary biliary cirrhosis
• Certain inherited metabolic diseases such as hereditary hemochromatosis 
• Heavy alcohol use
• Tobacco use
• Obesity
• Type 2 diabetes
• Certain rare diseases
  • Tyrosinemia
  • Alpha1-antitrypsin deficiency
  • Porphyria cutanea tarda
  • Glycogen storage diseases
  • Wilson disease
• Aflatoxins
  • Cancer-causing substances are made by a fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice
  • Developed countries, such as the U.S. and those in Europe, test foods for levels of aflatoxins
• Vinyl chloride and thorium dioxide (Thorotrast)
• Anabolic steroid use

In addition to a patient history and physical examination, tests used to diagnose hepatocellular carcinoma include: 

• Imaging tests
  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Angiography
  • Bone scan
• Biopsy
  • Needle biopsy 
  • Laparoscopic biopsy
  • Surgical biopsy
• Blood tests
  • Alpha-fetoprotein blood (AFP) test
  • Tests for viral hepatitis 
  • Liver function tests (LFTs)
  • Blood clotting tests
  • Kidney function tests: blood urea nitrogen (BUN) and creatinine levels 
  • Complete blood count (CBC)
  • Blood chemistry tests 
  • Other tests including calcium levels, blood glucose levels, and cholesterol levels

Treatments for hepatocellular carcinoma can include one or more of the following:

• Surgery 
  • Partial hepatectomy to remove part of the liver
  • Liver transplant
• Ablation: destroys liver tumors without removing them
  • Radiofrequency ablation (RFA)
  • Microwave ablation (MWA) 
  • Cryoablation (cryotherapy)
  • Ethanol (alcohol) ablation (also called percutaneous ethanol injection, or PEI) 
• Embolization therapy: injects substances directly into an artery in the liver to block or reduce the blood flow to a tumor in the liver
  • Trans-arterial embolization (TAE)
  • Trans-arterial chemoembolization (TACE) 
  • Drug-eluting bead chemoembolization (DEB-TACE)
  • Radioembolization (RE)
• Radiation therapy 
  • External beam radiation therapy (EBRT) 
  • Stereotactic body radiation therapy (SBRT)
• Targeted drug therapy 
  • Kinase inhibitors
    • Sorafenib (Nexavar) and lenvatinib (Lenvima)
    • Regorafenib (Stivarga) and cabozantinib (Cabometyx)
• Monoclonal antibodies
  • Bevacizumab (Avastin)
  • Ramucirumab (Cyramza)
• Immunotherapy 
  • PD-1 and PD-L1 inhibitors
    • Atezolizumab (Tecentriq) 
    • Pembrolizumab (Keytruda) and nivolumab (Opdivo) 
  • CTLA-4 inhibitors
    • Ipilimumab (Yervoy) 
• Chemotherapy 
  • Gemcitabine (Gemzar)
  • Oxaliplatin (Eloxatin)
  • Cisplatin (Platinol, Platinol-AQ)
  • Doxorubicin (pegylated liposomal doxorubicin)
  • 5-fluorouracil (5-FU)
  • Capecitabine (Xeloda)
  • Mitoxantrone (Novantrone)

Many liver cancers may be prevented by reducing risk factors. 

• Avoid and treat hepatitis B and C infections
  • Get the HBV vaccine 
  • Treat chronic HCV infection
• Limit alcohol and tobacco use
• Lose weight or maintain a healthy weight
• Limit exposure to cancer-causing chemicals such as aflatoxins
• Treat diseases that increase liver cancer risk such as hemochromatosis