Hepatocellular carcinoma in cirrhotic liver

Hepatocellular carcinoma (HCC) is a primary malignant tumour (cancer) of the liver. Most HCCs occur in livers that have been damaged by chronic disease processes like cirrhosis. Thus HCC is a 'tumour in a tumour generating environment'.Certain patients with liver disease eg those with tyrosinaemia, haemochromatosis or hepatitis B are at much higher risk of developing cancers than others. Once HCC develops, the chances of survival decline rapidly unless detected and managed early. Hence all cirrhotics should be under surveillance for HCC with ultrasound and alpha-fetoprotein (AFP) levels at least every 6 months. When HCC is suspected this should be supplemented by contrast axial imaging (CT/MRI) and/or biopsy. Biopsy can be hazardous in patients with advanced disease due to ascites, coagulopathy and risk of tumour spread. Without a biopsy it may be difficult to conclusively prove or disprove presence of HCC since no imaging or tumour marker is 100% accurate. If the suspicion is strong and biopsy is considered very risky, the patient should be assumed to be having HCC and treated as such.