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Hepatocellular carcinoma.
Last reviewed: 12.07.2025
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Hepatocellular carcinoma develops in 5-15% of patients with alcoholic liver cirrhosis. The role of alcohol in carcinogenesis has not yet been sufficiently elucidated. An increased incidence of cancer of the oral cavity (except for the lips), pharynx, larynx, and esophagus has been established in patients with chronic alcoholism. The overall mortality rate from cancer of all localizations in patients with chronic alcoholism is 25% higher than the average in the population. An experiment has shown that the main metabolite of ethanol, acetaldehyde, causes chromosome damage in human cell culture. Carcinogens may also be present in a number of alcoholic beverages. Traces of nitrosamines, propanol, methylbutanol, and polycyclic hydrocarbons have been found in alcoholic beverages. Ethanol is a good solvent and promotes the penetration of carcinogens into tissues. In addition, ethanol activates microsomal enzymes and can promote the biotransformation of procarcinogens into obligate carcinogens, mutagens and teratogens.
Every year, 1,250,000 people die from hepatocellular carcinoma worldwide. Among tumors affecting humans, hepatocellular carcinoma ranks seventh. The prevalence of the tumor depends on the geographic area. Hepatocellular carcinoma is most common in residents of African and Asian countries, where it almost always develops against the background of liver cirrhosis. In Southeast Asian countries, hepatocellular carcinoma is the second most common malignant tumor. The incidence of the disease is also increasing in Western countries, which is probably due to the prevalence of viral hepatitis B and C, which is the most common cause of hepatocellular carcinoma.
Causes of Hepatocellular Carcinoma
In Northern Europe and North America, the risk of developing primary hepatocellular carcinoma is four times higher among alcoholics, especially the elderly. They always show signs of cirrhosis, and alcohol itself is not a liver carcinogen.
What causes hepatocellular carcinoma?
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Pathogenesis of hepatocellular carcinoma
In terms of malignancy, liver tumors can correspond to the entire range - from benign regeneration nodes to malignant tumors. Dysplasia of hepatocytes occupies an intermediate position. The probability of malignancy is especially high in the presence of small dysplastic hepatocytes. An increase in the density of tumor cell nuclei by 1.3 times or more compared to the density of normal hepatocyte nuclei indicates highly differentiated hepatocellular carcinoma.
Symptoms of Hepatocellular Carcinoma
The symptoms of hepatocellular carcinoma are quite polymorphic. The course of the disease may be asymptomatic; in this case, patients show only signs of liver cirrhosis. The tumor may be diagnosed accidentally. However, the clinical manifestations may be so vivid, and liver failure - so pronounced, that the clinical picture resembles that of a liver abscess. The spectrum of manifestations lies between these two extreme clinical forms of the disease.
Where does it hurt?
What's bothering you?
Diagnosis of hepatocellular carcinoma
On computed tomography (CT), hepatocellular carcinoma appears as a low-density lesion. CT often does not allow determining the size and number of tumors, especially in the presence of cirrhosis. It is also important to conduct a study with contrast. The picture with HCC is mosaic, multiple nodes with varying degrees of signal attenuation and clearly defined partitions separating the tumor mass are visible. The tumor may be encapsulated. Fatty liver degeneration is often noted. Infiltration of the portal vein and the presence of arterioportal shunts are possible.
Diagnosis of hepatocellular carcinoma
What do need to examine?
What tests are needed?
Who to contact?
Treatment of hepatocellular carcinoma
It is necessary to determine the exact location of the tumor, especially when planning surgical intervention. The method of choice is CT, as well as its combination with angiography. CT can be combined with contrasting of the hepatic artery with iodolipol, which allows detecting 96% of tumors. However, this method complicates diagnostics and is not always necessary.
The only radical method of treating hepatocellular carcinoma is surgery, which involves liver resection or transplantation.
Prognosis of hepatocellular carcinoma
The prognosis for hepatocellular carcinoma is usually extremely poor. The time interval between HBV or НСV infection and tumor development ranges from several years to many decades.