Materiały źródłowe

• #1 Hepatocellular Carcinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559177/

  Hepatocellular carcinoma (HCC) is a primary tumor of the liver and constitutes more than 90% of the primary tumor of the liver. HCC occurs in approximately 85% of patients diagnosed with cirrhosis. […] The presentation of hepatocellular carcinoma (HCC) is dependent on the stage of the tumor and background cirrhosis. Non-cirrhotic related HCC may present asymptomatic in the early stage of the disease. The median age of the clinical presentation of HCC is 69 years. […] Cirrhotic-related HCC patients may present with symptoms of decompensated liver failure, including worsening jaundice, pruritus, hepatic encephalopathy, ascites, palpable mass in the upper abdomen, fever, malaise, weight loss, early satiety, abdominal distension, and cachexia. Abdominal pain is the commonest presentation for HCC.

• #1 Liver cancer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-20353659

  Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include unintentional weight loss, loss of appetite, upper abdominal pain, nausea and vomiting, general weakness and fatigue, abdominal swelling, jaundice where your eyes and skin turn yellow, and white, chalky stools. […] Most liver cancers occur in people with an underlying liver disease. But sometimes liver cancer happens in people with no underlying liver disease and it’s not exactly clear why. […] Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell’s DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor a mass of cancerous cells.

• #1 Liver cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/liver-cancer

  In the early stages of liver cancer (HCC), there are often no symptoms. […] If you develop HCC, these tests may find it before you have any symptoms. Symptoms may include: loss of appetite, weight loss, feeling sick, jaundice. […] We have more information about these and other possible the symptoms of HCC.

• #1 Signs and Symptoms of Liver Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/signs-symptoms.html

  People who have chronic hepatitis or cirrhosis might feel worse than usual or just have changes on lab test results, such as liver function tests or alpha-fetoprotein (AFP) levels. […] Having one or more of the signs or symptoms above does not mean you have liver cancer. In fact, many of these signs and symptoms are more likely to be caused by other conditions. Still, if you have any of them, its important to have them checked by a doctor so that the cause can be found and treated, if needed.

• #1 End stage liver cancer: Symptoms timeline and life expectancy

  https://www.medicalnewstoday.com/articles/end-stage-liver-cancer-timeline

  Symptoms that may indicate end stage liver cancer include increased fatigue, abdominal pain, and jaundice, which is the yellowing of the skin and mucus membranes. […] The following symptoms may indicate end stage liver cancer. Certain symptoms may also indicate that a person is nearing the end of life. […] Some of the most common symptoms of late-stage liver cancer are: unintended weight loss, appetite loss, a feeling of fullness even after a small meal, vomiting, nausea, enlarged liver, enlarged spleen, abdominal pain, pain near the right shoulder blade, itching, jaundice. […] People with cancer who are nearing the end of life may have the following symptoms: fatigue and extreme tiredness, shortness of breath or irregular breathing, pain, coughing, constipation, difficulty swallowing, delirium and hallucinations, decreased urine, which may also be darker than usual, changes in heart rate, decreased blood pressure, cold hands and feet, which may look blotchy or blue, a rattling sound when breathing, which is due to saliva or fluids collecting in the throat and airways, muscle jerking, fever, heavy bleeding.

• #1 18 Top Liver Cancer Symptoms & Signs | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/liver-cancer/liver-cancer-symptoms.html

  Primary liver cancer usually does not cause symptoms in the early stages. When it does have symptoms, they vary from person to person. As the tumor grows, it may cause: Unintended weight loss […] Pain in the right side of the upper abdomen or around the right shoulder blade […] Loss of appetite […] Swelling or bloating in the abdomen […] Feeling of fullness after a small meal […] Hard lump below the ribs on the right side […] Tiredness or weakness […] Nausea or vomiting […] Jaundice: Yellowing of the skin and whites of the eyes. Jaundice is caused by high levels of bilirubin, a yellow pigment that results from the breakdown of red blood cells. It is usually processed by the liver and passes through the bile ducts before being excreted. Excess bilirubin can be a sign of liver or bile duct malfunction.

• #1 Liver cancer – hepatocellular carcinoma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/liver-cancer-hepatocellular-carcinoma

  Hepatocellular carcinoma is cancer that starts in the liver. […] Hepatocellular carcinoma is the most common type of liver cancer. It occurs more often in men than women. It is most often diagnosed in people age 50 or older. […] Symptoms of liver cancer may include any of the following: Abdominal pain or tenderness, especially in the upper-right part; Easy bruising or bleeding; Enlarged abdomen due to fluid in the abdomen (ascites); Yellow skin or eyes (jaundice); Unexplained weight loss. […] If the cancer can’t be completely treated, the disease is usually fatal. But survival can vary, depending on how advanced the cancer is and how successful treatment is. […] Contact your provider if you develop ongoing abdominal pain, especially if you have a history of liver disease.

• #1 Hepatocellular Carcinoma – Liver and Gallbladder Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/tumors-of-the-liver/hepatocellular-carcinoma

  Hepatocellular carcinoma is a cancer that begins in the liver cells and is the most common of the primary liver cancers. […] People may have abdominal pain, lose weight, and feel a large mass in the upper right part of the abdomen. […] Most commonly, there are no symptoms of hepatocellular carcinoma before diagnosis, and tumors are found during a routine screening. Usually, the first symptoms are abdominal pain, weight loss, and a large mass that can be felt in the upper right part of the abdomen. […] A fever may occur. Occasionally, the first symptoms are sudden abdominal pain and shock (dangerously low blood pressure) caused by rupture or bleeding of the cancer. […] This cancer is usually fatal unless it is diagnosed early. […] Most people with hepatocellular carcinoma do not live for more than a few years because the cancer is detected at a late stage. Screening and early detection result in a better prognosis. If the cancer is small and has not spread and liver transplantation or surgical removal can be done, the person can often live a number of years.

• #1 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  With early hepatocellular cancer (HCC), you may not have any symptoms. More advanced HCC may have symptoms. They may be quite vague, especially if you already have symptoms from other liver disease, such as hepatitis or cirrhosis. You may just find you […] feel sick […] have no appetite, or feel full after eating very little […] lose weight without trying. […] Other symptoms of HCC are listed below. Remember that many of them are common to other liver diseases. If you have hepatitis or cirrhosis, tell your doctor if you have any new symptoms or your symptoms are getting worse. […] With HCC, you may have […] tummy (abdominal) pain – this happens in between 50 and 95 out of 100 people (50-95%) […] abdominal swelling (ascites) […] feeling generally unwell and lacking in energy (malaise) […] pain in your right shoulder – because the enlarged liver is irritating nerves that supply the shoulder […] jaundice – yellowing of the skin and whites of the eyes.

• #1 Metastatic Stage 4 Liver Cancer: Symptoms and What to Expect

  https://www.cancercenter.com/cancer-types/liver-cancer/types/metastatic-liver-cancer

  Liver cancer symptoms often do not appear in the early stages. As a result, liver cancer tends to be diagnosed at a more advanced stage. […] The symptoms of metastatic liver cancer vary depending on where new tumors form. For example, if the liver cancer spreads to the bones, it may cause bone fractures. […] Common symptoms of stage 4 liver cancer include: abdominal pain, pain occurring near the right shoulder blade or in the upper abdomen, loss of appetite, weight loss or nausea, abdominal swelling or bloating in the abdomen, yellowing of the skin and eyes (jaundice), ongoing fatigue or weakness, unexplained fever. […] Patients with stage 4 liver cancer may experience worsening symptoms such as increasing jaundice, pain, difficulty eating and strong fatigue. Patients should talk to their care teams about ways to manage these symptoms, to help improve their quality of life.

• #1 Symptoms of Hepatocellular Carcinoma and Slowing Disease Progression

  https://www.healthline.com/health/treating-hcc/hcc-symptoms

  HCC can cause you to bleed or bruise more easily than usual. […] Pain in the right upper quadrant of the abdomen is one of the most frequently reported symptoms in people with HCC. […] The early stages of HCC typically progress slowly. […] If the cancer is discovered early enough, it can sometimes be cured. […] However, cirrhosis, which is common in most people with HCC, can complicate treatment. […] Nonsurgical treatments are the most common way to ease symptoms and slow down disease progression in people with HCC. […] The median survival rate is typically between 6 and 20 months after diagnosis. […] The suboptimal survival rate is often attributed to the fact that HCC is usually not diagnosed until it has reached an advanced stage. […] Symptoms of HCC include: jaundice, pain, weight loss, swelling in the abdomen. […] However, signs of the disease often dont become noticeable until the disease has reached an advanced state. […] It may be possible to slow down the progression of HCC through various treatments.

• #1 Signs and Symptoms of Liver Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/signs-symptoms.html

  Signs and symptoms of liver cancer often do not show up until the later stages of the disease, but sometimes they may show up sooner. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed earlier, when treatment is most likely to be successful. […] Some of the most common symptoms of liver cancer are: Weight loss (without trying), Loss of appetite, Feeling very full after a small meal, Nausea or vomiting, An enlarged liver, felt as fullness under the ribs on the right side, An enlarged spleen, felt as fullness under the ribs on the left side, Pain in the abdomen (belly) or near the right shoulder blade, Swelling or fluid buildup in the abdomen (belly), Itching, Yellowing of the skin and whites of the eyes (jaundice), Fever, Enlarged veins on the belly that can be seen through the skin, Abnormal bruising or bleeding.

• #1 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  Swelling may be caused by an enlarged liver or by fluid collecting in the tummy (abdomen). The liver is responsible for making proteins that keep fluid in the bloodstream. Without these, fluid tends to seep out and can pool around the abdominal organs. […] Doctors call this ascites (say: a-site-eez). You may also notice other swelling, such as puffy ankles. […] Jaundice (say: jawn-diss) is caused by the cancer blocking one or more of the bile ducts. Bile then gets backed up in the liver, so you can’t get rid of bilirubin. This waste product from recycling red blood cells is normally processed by the liver. The bilirubin collects in the bloodstream and other body tissues, causing yellowing. […] Other symptoms related to jaundice are: […] itching, caused by a build up of bile salts in the skin […] very dark wee from bilirubin in the urine […] pale, putty-coloured poo (bowel movements) because bile salts are not passing through and colouring the poo brown.

• #1 18 Top Liver Cancer Symptoms & Signs | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/liver-cancer/liver-cancer-symptoms.html

  Itching: Itchy skin can be caused when excess levels of bilirubin reach the skin. […] Pale stools […] Dark urine […] Swollen veins on the abdomen […] Becoming sicker if you have hepatitis or cirrhosis. Certain types of liver cancer produce hormones that may cause: High blood-calcium levels that may cause constipation, nausea or confusion […] Low blood-sugar levels that may cause tiredness or feeling faint […] Enlarged breasts or shrinking of testicles in men […] High red-blood cell count that may cause redness in the face. These symptoms do not always mean you have liver cancer. However, it is important to discuss any symptoms with your doctor since they may signal other health problems.

• #1 Liver cancer – hepatocellular carcinoma: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000280.htm

  Hepatocellular carcinoma is cancer that starts in the liver. […] Hepatocellular carcinoma is the most common type of liver cancer. It occurs more often in men than women. It is most often diagnosed in people age 50 or older. […] Symptoms of liver cancer may include any of the following: Abdominal pain or tenderness, especially in the upper-right part; Easy bruising or bleeding; Enlarged abdomen due to fluid in the abdomen (ascites); Yellow skin or eyes (jaundice); Unexplained weight loss. […] If the cancer can’t be completely treated, the disease is usually fatal. But survival can vary, depending on how advanced the cancer is and how successful treatment is.

• #1 What Is Liver Cancer? – NCI

  https://www.cancer.gov/types/liver/what-is-liver-cancer

  Most adult primary liver cancers are hepatocellular carcinomas. This type of liver cancer is the third leading cause of cancer-related deaths worldwide. […] These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following: a hard lump on the right side just below the rib cage, discomfort in the upper abdomen on the right side, a swollen abdomen, pain near the right shoulder blade or in the back, jaundice (yellowing of the skin and whites of the eyes), easy bruising or bleeding, unusual tiredness or weakness, nausea and vomiting, loss of appetite or feelings of fullness after eating a small meal, weight loss for no known reason, pale, chalky bowel movements and dark urine, fever.

• #1 Hepatocellular Carcinoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559177/

  Symptomatic patients may present with variceal bleeding, intraperitoneal bleeding, obstructive jaundice, pyogenic liver abscess, and hepatic encephalopathy. […] Five-year survival of HCC is 18% and second to pancreatic cancer. The prognosis of patients with HCC is dependent on the tumor size, differentiation or grade of the tumor on histopathology, severity of the underlying liver disease, presence or absence of metastases, and tumor extension to adjacent structures.

• #1 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  Early on, you may have few other symptoms from jaundice. Later, it can cause flu-like symptoms, including fever, aching muscles and feeling weak and tired. You may also feel sick. […] Around 1 in 5 people (20%) have odd symptoms caused by the liver tumours making hormones. Doctors call this paraneoplastic syndrome. One in 10 people (10%) have this when they first go to the doctor. The commonest are: […] high blood calcium, causing sickness, weakness and constipation. If not treated, patients become confused and increasingly drowsy […] low blood sugar causing tiredness, weakness and fainting. […] Sadly, in up to 4 out of 10 people (40%) the cancer has already spread before it’s diagnosed. If it has spread to the bones, you may have bone pain or sudden bone fractures for little or no reason. If it spreads to the lungs, it can cause cough and shortness of breath.

• #1 Tumor initiation and progression in hepatocellular carcinoma: risk factors, classification, and therapeutic targets | Acta Pharmacologica Sinica

  https://www.nature.com/articles/aps2010142

  Hepatocellular carcinoma (HCC) is a major health problem worldwide responsible for 500 000 deaths annually. A number of risk factors are associated with either the induction of the disease or its progression; these include infection with hepatitis B or C virus, alcohol consumption, non-alcoholic steatohepatitis and certain congenital disorders. […] In around 80% of the cases, HCC is associated with cirrhosis or advanced fibrosis and with inflammation and oxidative stress. […] HCC development is recognized as a multistep process that normally develops over many years. Over this period several mutations accumulate in the cell and that stimulate malign transformation, growth, and metastatic behavior. […] Cirrhosis is associated with the development of HCC, but the molecular basis for the cancer-promoting effect of cirrhosis remains far from clear.

• #1 The Progression of Liver Disease to Liver Cancer – American Liver Foundation

  https://liverfoundation.org/resource-center/videos/the-progression-of-liver-disease-to-liver-cancer/

  The pathogenesis of a liver disease becoming an HCC is a complex multi-step process. When a liver gets damaged, the liver tries to regenerate and replace the damaged cells. This repair process involves production of collagen which are fibers that stiffen the cells. Chronic liver disease leads to persistent activation of this repair process. It will make the liver more and more stiffer, and all the collagen will replace the healthy cells. This is what we typically call a scarring of the liver, or fibrosis. If left untreated, this scarring will continue to a severely scarred state of the liver, and we call that a cirrhosis. […] Cirrhotic livers are more prone to accumulate DNA mutations. These mutations interfere with the normal cell cycle (such as the growth and division of cells) and the cells instead of regenerating properly, will accumulate together to form nodules. These are called dysplastic nodules and they are pre-cancerous.

• #1 Progression of chronic liver disease to hepatocellular carcinoma: implications for surveillance and management | BJC Reports

  https://www.nature.com/articles/s44276-024-00050-0

  Current opinion holds that hepatocellular carcinoma (HCC) arises as a stepwise progression from chronic liver disease (CLD) to cirrhosis and then to HCC. […] Among HCC patients, 28% had no indication of cirrhosis prior to HCC diagnosis. Only 31% of HBV-related HCC cases followed the cirrhotic pathway. HCV patients who achieved sustained virological response (SVR) developed cirrhosis approximately 7 years before HCC diagnosis. […] Our analysis challenges the notion of cirrhosis as an obligatory stage of HCC development in CLD patients. […] In total, HCC developed in 172 patients representing 7% of all cases who were non-cirrhotic at entry into the surveillance programme. […] In particular, of the 172 patients developing HCC, 124 (72%) had Fib-4 values of 3.25 at some time before HCC was diagnosed indicating their eventual progression to liver cirrhosis.

• #1 Hepatic Progression of Hepatocellular Carcinoma | IntechOpen

  https://www.intechopen.com/chapters/82946

  Hepatocellular carcinoma constitutes an ongoing challenge due to its incidence and the high mortality related to it. Metastases and relapses even after treatment with curative intent are frequent. […] The risk of recurrence in HCC is high because of the biological and morphological nature of the liver. Recurrent disease includes both intrahepatic metastasis, which usually form within the first 2 years of diagnosis, and de novo cancer that generally occurs later. The hepatic vascular anatomy and immunological characteristics create a pro-neoplastic niche for metastasis, while the continuing damage to the liver creates pro-neoplastic sites susceptible to secondary tumors. Liver metastasis represents a big challenge in the battle against cancer because they have a high mortality rate. Around 30-70% of patients die with liver metastasis, and metastasis is responsible for more than 90% cancer mortality.

• #1 Metastatic Stage 4 Liver Cancer: Symptoms and What to Expect

  https://www.cancercenter.com/cancer-types/liver-cancer/types/metastatic-liver-cancer

  When liver cancer metastasizes, it most commonly spreads to the lungs and bones. The five-year survival rate for a patient whose liver cancer has spread to surrounding tissue, organs and/or lymph nodes is estimated at 12 percent. The five-year survival rate for a patient whose liver cancer has spread to distant tissue, organs and/or lymph nodes is estimated at 3 percent.

• #1 Hepatocellular Carcinoma (HCC): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/197319-overview

  Complications from HCC are those of hepatic failure; death occurs from cachexia, variceal bleeding, or (rarely) tumor rupture and bleeding into the peritoneum. Signs and symptoms of hepatic failure may signify tumor recurrence and/or progression. […] Tumors are multifocal within the liver in 75% of cases. Late in the disease, metastases may develop in the lung, portal vein, periportal nodes, bone, or brain.

• #1 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  This isn’t really a symptom of HCC, but rather a complication of advanced liver disease. Doctors call it hepatic encephalopathy (say: en-keff-al-op-ath-ee). Toxins build up in the blood because the liver is not working well enough to remove them. They can cause mental changes, such as confusion, forgetfulness and poor concentration. If not treated people can become drowsy and confused.

• #1 Symptom Management in Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2881685/

  HCC patients in the terminal stage of disease may present with a variety of symptoms related to decompensated cirrhosis. These include ascites, variceal bleeding, peripheral edema, and hepatic encephalopathy. […] Other common complaints include fatigue or weakness, peripheral edema, cachexia, ascites, dyspnea, anorexia, and vomiting. […] Jaundice presents in 19% to 40% of patients with HCC at the time of diagnosis and usually occurs in later stages. […] The management of obstructive jaundice in HCC patients can be achieved using percutaneous drainage or the placement of a biliary stent. […] The accumulation of ascites is a result of an imbalance in the normal state of influx and efflux of fluid from the peritoneal cavity. […] Diuretics remain the gold standard in management of ascites in cancer patients.

• #1 What is The Last Stage Of Liver Cancer? – Dr Praveen Kammar

  https://drpraveenkammar.com/blogs/what-is-the-last-stage-of-liver-cancer/

  Liver cancer can occur when the liver cells grow abnormally, out of control. […] The last stage cancer or stage 4 liver cancer is the one that has spread to the nearby lymph nodes and/or distant sites within the body. […] This end-stage liver cancer is complicated because most patients have significant liver damage that ultimately limits the organs function. […] Reduced liver function may cause severe, even life-threatening conditions and have implications when choosing treatment options. […] Symptoms of last-stage liver cancer include: Jaundice, Bleeding from trivial injuries, The buildup of fluid in the abdomen and legs, Reduced brain function (problems with memory and concentration), Muscle cramps, Trouble sleeping at night, Extreme fatigue, Intense itching, Decreased appetite. […] When the liver function declines in end-stage liver cancer, certain medications further harm the liver or build up in the bloodstream, causing severe side effects. This requires immediate medical attention.

• #1 Liver Cancer: Symptoms, Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9418-liver-cancer

  Data show that 21% of people with HCC or ICC are alive five years after their diagnosis. A relative survival rate compares two sets of five-year survival rates. One rate is the percentage of people with a specific disease. The other rate is people who don’t have the disease. In this case, 21% of people with HCC or ICC were alive five years after their diagnosis. By comparison, 79% of people in the general population were alive after that same time. […] Further, researchers break down survival rates by cancer stage. The five-year survival rate for early-stage (stage I or stage II) liver cancer is 37%. That survival rate drops to 13% for stage III liver cancer and 3% for stage IV liver cancer. […] Primary liver cancer is a life-threatening illness. You may not know you have liver cancer until it’s in an advanced stage. That limits your treatment options. Your healthcare team will do treatments to keep cancer from growing. They’ll also offer treatments to ease your symptoms and maintain your quality of life.

• #1 Hepatocellular Carcinoma (HCC): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/197319-overview

  Hepatocellular carcinoma (HCC) is a primary malignancy of the liver that occurs predominantly in patients with underlying chronic liver disease and cirrhosis. However, up to 25% of patients have no history of cirrhosis or risk factors for it. […] The presentation of HCC has evolved significantly over the past few decades. Whereas in the past, patients with HCC generally presented at an advanced stage, with right-upper-quadrant pain, weight loss, and signs of decompensated liver disease, HCC is now increasingly recognized at a much earlier stage as a consequence of the routine screening of patients with known cirrhosis, using ultrasonography with or without serum alpha-fetoprotein (AFP) measurements. […] Overall prognosis for survival is poor, with a 5-year relative survival rate of 21.6%. By stage, the relative 5-year survival is 37.3% in patients diagnosed with localized disease, 14.3% with regional disease, and 3.5% with distant disease. Length of survival depends largely on the extent of cirrhosis in the liver; cirrhotic patients have shorter survival times and more limited therapeutic options.

• #1 Hepatocellular carcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Hepatocellular_carcinoma

  The prognosis of HCC is affected by the staging of the tumor, the liver’s function due to the effects of chronic liver disease and cirrhosis as well as the person’s physical performance status. The usual outcome is poor because only 10-20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually deadly within 3 to 6 months. This is partially due to late presentation with tumors, but also the lack of medical expertise and facilities in the regions with high HCC prevalence. However, survival can vary, and occasionally people survive much longer than 6 months.

• #1

  https://www.nuhs.edu.sg/patient-care/find-a-condition/hepatocellular-carcinoma

  Most patients with HCC do not have any symptoms especially in the early stage of the disease. In the later stages, patients may develop jaundice, confusion, bleeding tendencies or fluid in their abdomen known as ascites. […] It is possible to detect HCC early in the absence of symptoms. Patients with risk factors for HCC should undergo screening every six months using ultrasound of the liver and by undergoing a liver tumour blood test (alpha-fetoprotein).

• #1 Clinical features and diagnosis of hepatocellular carcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hepatocellular-carcinoma

  Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in patients with cirrhosis due to alcohol use, chronic hepatitis B or C virus infections, or metabolic dysfunction-associated steatohepatitis. […] HCC is frequently diagnosed late in its course for two reasons: the absence of symptoms in patients with early disease, and the reluctance of some clinicians to provide surveillance for high-risk patients. […] As a result, many patients have advanced disease at the time of diagnosis. […] The five-year survival rate for patients whose tumors are detected at an early stage and who receive treatment exceeds 70 percent.

• #2 Hepatocellular carcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Hepatocellular_carcinoma

  Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC most commonly occurs in those with chronic liver disease especially those with cirrhosis or fibrosis, which occur in the setting of chronic liver injury and inflammation. Chronic liver diseases which greatly increase the risk of HCC include hepatitis infection such as (hepatitis B, C or D), non-alcoholic steatohepatitis (NASH), alcoholic liver disease, or exposure to toxins such as aflatoxin, or pyrrolizidine alkaloids. The five-year survival in those with HCC is 18%. […] Most cases of HCC occur in people who already have signs and symptoms of chronic liver disease. They may present with worsening symptoms or without symptoms at the time of cancer detection. HCC may present with non-specific symptoms such as abdominal pain, nausea, vomiting, or feeling tired. Some symptoms that are more closely associated with liver disease include yellow skin (also called jaundice), abdominal swelling due to fluid in the abdominal cavity, easy bruising from blood clotting abnormalities, loss of appetite, unintentional weight loss, abdominal pain, nausea, vomiting, or feeling tired.

• #2 Symptoms of Hepatocellular Carcinoma and Slowing Disease Progression

  https://www.healthline.com/health/treating-hcc/hcc-symptoms

  Hepatocellular carcinoma (HCC) is a type of liver cancer that begins in the hepatocytes, the main type of liver cell. […] Symptoms often dont appear until the later stages of the cancer. […] Most of the time, people with liver cancer dont notice symptoms until the disease progresses into later stages. However, its possible for signs to show up sooner. Here are some of the most common symptoms of HCC. […] Nausea or feelings of queasiness is a common symptom of HCC. […] Another early symptom of HCC is loss of appetite. […] Liver cancer can also cause you to lose weight, even if youre not actively trying to change the number on the scale. […] Fatigue can develop into extreme sleepiness as HCC progresses. […] Jaundice is the yellowing of the skin, eyes, or mucus membranes. […] High pressure in the liver veins can cause ascites, or an accumulation of fluid in the belly.

• #2 Clinical features and diagnosis of hepatocellular carcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hepatocellular-carcinoma

  Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in patients with cirrhosis due to alcohol use, chronic hepatitis B or C virus infections, or metabolic dysfunction-associated steatohepatitis. […] HCC is frequently diagnosed late in its course for two reasons: the absence of symptoms in patients with early disease, and the reluctance of some clinicians to provide surveillance for high-risk patients. […] As a result, many patients have advanced disease at the time of diagnosis. […] The five-year survival rate for patients whose tumors are detected at an early stage and who receive treatment exceeds 70 percent.

• #2 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  With early hepatocellular cancer (HCC), you may not have any symptoms. More advanced HCC may have symptoms. They may be quite vague, especially if you already have symptoms from other liver disease, such as hepatitis or cirrhosis. You may just find you […] feel sick […] have no appetite, or feel full after eating very little […] lose weight without trying. […] Other symptoms of HCC are listed below. Remember that many of them are common to other liver diseases. If you have hepatitis or cirrhosis, tell your doctor if you have any new symptoms or your symptoms are getting worse. […] With HCC, you may have […] tummy (abdominal) pain – this happens in between 50 and 95 out of 100 people (50-95%) […] abdominal swelling (ascites) […] feeling generally unwell and lacking in energy (malaise) […] pain in your right shoulder – because the enlarged liver is irritating nerves that supply the shoulder […] jaundice – yellowing of the skin and whites of the eyes.

• #2 Symptom Management in Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2881685/

  Worldwide, hepatocellular carcinoma (HCC) causes approximately one million deaths every year. […] The occurrence of multiple symptoms in HCC patients is common, and may include pain, fatigue, weight loss, and obstructive syndromes such as ascites and jaundice. […] HCC is often diagnosed at advanced stages and prognosis is generally poor when the tumor is unresectable. This extremely guarded prognosis is frequently coupled with severe symptom occurrence including pain, fatigue, anorexia, and ascites. […] Patients with HCC are usually asymptomatic during the early stages of disease. Unfortunately, 80% of patients with HCC will be diagnosed with advanced stage disease. […] Between 90-95% of HCC patients will present with the triad of right upper quadrant pain, palpable mass, and weight loss.

• #2 Liver cancer – hepatocellular carcinoma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/liver-cancer-hepatocellular-carcinoma

  Hepatocellular carcinoma is cancer that starts in the liver. […] Hepatocellular carcinoma is the most common type of liver cancer. It occurs more often in men than women. It is most often diagnosed in people age 50 or older. […] Symptoms of liver cancer may include any of the following: Abdominal pain or tenderness, especially in the upper-right part; Easy bruising or bleeding; Enlarged abdomen due to fluid in the abdomen (ascites); Yellow skin or eyes (jaundice); Unexplained weight loss. […] If the cancer can’t be completely treated, the disease is usually fatal. But survival can vary, depending on how advanced the cancer is and how successful treatment is. […] Contact your provider if you develop ongoing abdominal pain, especially if you have a history of liver disease.

• #2 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  Swelling may be caused by an enlarged liver or by fluid collecting in the tummy (abdomen). The liver is responsible for making proteins that keep fluid in the bloodstream. Without these, fluid tends to seep out and can pool around the abdominal organs. […] Doctors call this ascites (say: a-site-eez). You may also notice other swelling, such as puffy ankles. […] Jaundice (say: jawn-diss) is caused by the cancer blocking one or more of the bile ducts. Bile then gets backed up in the liver, so you can’t get rid of bilirubin. This waste product from recycling red blood cells is normally processed by the liver. The bilirubin collects in the bloodstream and other body tissues, causing yellowing. […] Other symptoms related to jaundice are: […] itching, caused by a build up of bile salts in the skin […] very dark wee from bilirubin in the urine […] pale, putty-coloured poo (bowel movements) because bile salts are not passing through and colouring the poo brown.

• #2 Liver Cancer Symptoms, Prognosis, Treatment, Causes, Screening

  https://www.medicinenet.com/liver_cancer_hepatocellular_carcinoma/article.htm

  Liver cancer causes no symptoms of its own. As the tumor grows, it may cause symptoms of pain in the right side of the abdomen or feeling overly full after eating a small amount. Some patients may have worsening symptoms of chronic liver disease or cirrhosis, which often precedes the development of cancer of the liver. For example, patients may complain of: […] unexplained weight loss, wasting (cachexia), […] decreased appetite, […] nausea or vomiting, […] a feeling of an enlarged liver (feeling a mass under the ribs on the right side), […] enlarged spleen (feeling a mass under the ribs on the left side), […] pain in the abdomen or near the right shoulder blade, […] increased swelling of the feet and belly, […] fluid build-up in the belly, […] itching, […] swollen legs, and

• #2 Symptoms of liver cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/liver-cancer/symptoms

  Jaundice is the yellowing of the skin and the whites of the eyes. It is caused by a blockage in the bile duct or your liver not working properly. […] Liver cancer can cause swelling of the tummy (abdomen). This might be because the liver gets bigger from the growing cancer, and causes swelling on the right side of your abdomen. The cancer increases pressure in the liver causing blood to back up in the vessels (veins). This forces fluid out of the veins into the abdomen (ascites). A swollen abdomen might cause discomfort or pain, and a loss of appetite or feeling full quickly. It can also cause breathlessness or swollen feet.

• #2 Symptoms of Hepatocellular Carcinoma and Slowing Disease Progression

  https://www.healthline.com/health/treating-hcc/hcc-symptoms

  HCC can cause you to bleed or bruise more easily than usual. […] Pain in the right upper quadrant of the abdomen is one of the most frequently reported symptoms in people with HCC. […] The early stages of HCC typically progress slowly. […] If the cancer is discovered early enough, it can sometimes be cured. […] However, cirrhosis, which is common in most people with HCC, can complicate treatment. […] Nonsurgical treatments are the most common way to ease symptoms and slow down disease progression in people with HCC. […] The median survival rate is typically between 6 and 20 months after diagnosis. […] The suboptimal survival rate is often attributed to the fact that HCC is usually not diagnosed until it has reached an advanced stage. […] Symptoms of HCC include: jaundice, pain, weight loss, swelling in the abdomen. […] However, signs of the disease often dont become noticeable until the disease has reached an advanced state. […] It may be possible to slow down the progression of HCC through various treatments.

• #2 What is The Last Stage Of Liver Cancer? – Dr Praveen Kammar

  https://drpraveenkammar.com/blogs/what-is-the-last-stage-of-liver-cancer/

  Liver cancer can occur when the liver cells grow abnormally, out of control. […] The last stage cancer or stage 4 liver cancer is the one that has spread to the nearby lymph nodes and/or distant sites within the body. […] This end-stage liver cancer is complicated because most patients have significant liver damage that ultimately limits the organs function. […] Reduced liver function may cause severe, even life-threatening conditions and have implications when choosing treatment options. […] Symptoms of last-stage liver cancer include: Jaundice, Bleeding from trivial injuries, The buildup of fluid in the abdomen and legs, Reduced brain function (problems with memory and concentration), Muscle cramps, Trouble sleeping at night, Extreme fatigue, Intense itching, Decreased appetite. […] When the liver function declines in end-stage liver cancer, certain medications further harm the liver or build up in the bloodstream, causing severe side effects. This requires immediate medical attention.

• #2 18 Top Liver Cancer Symptoms & Signs | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/liver-cancer/liver-cancer-symptoms.html

  Itching: Itchy skin can be caused when excess levels of bilirubin reach the skin. […] Pale stools […] Dark urine […] Swollen veins on the abdomen […] Becoming sicker if you have hepatitis or cirrhosis. Certain types of liver cancer produce hormones that may cause: High blood-calcium levels that may cause constipation, nausea or confusion […] Low blood-sugar levels that may cause tiredness or feeling faint […] Enlarged breasts or shrinking of testicles in men […] High red-blood cell count that may cause redness in the face. These symptoms do not always mean you have liver cancer. However, it is important to discuss any symptoms with your doctor since they may signal other health problems.

• #2 The Progression of Liver Disease to Liver Cancer – American Liver Foundation

  https://liverfoundation.org/resource-center/videos/the-progression-of-liver-disease-to-liver-cancer/

  The pathogenesis of a liver disease becoming an HCC is a complex multi-step process. When a liver gets damaged, the liver tries to regenerate and replace the damaged cells. This repair process involves production of collagen which are fibers that stiffen the cells. Chronic liver disease leads to persistent activation of this repair process. It will make the liver more and more stiffer, and all the collagen will replace the healthy cells. This is what we typically call a scarring of the liver, or fibrosis. If left untreated, this scarring will continue to a severely scarred state of the liver, and we call that a cirrhosis. […] Cirrhotic livers are more prone to accumulate DNA mutations. These mutations interfere with the normal cell cycle (such as the growth and division of cells) and the cells instead of regenerating properly, will accumulate together to form nodules. These are called dysplastic nodules and they are pre-cancerous.

• #2 The Progression of Liver Disease to Liver Cancer – American Liver Foundation

  https://liverfoundation.org/resource-center/videos/the-progression-of-liver-disease-to-liver-cancer/

  Additional damage and prolonged inflammation will provide these abnormal cells with proliferative, invasive, and survival advantages. including evading the bodys immune system, having an exclusive vascular supply to grow unchecked, and essentially becoming immortal cancer cells. Progressively, the dysplastic nodules transform into ultimately a hepatocellular carcinoma.

• #2 Progression of chronic liver disease to hepatocellular carcinoma: implications for surveillance and management | BJC Reports

  https://www.nature.com/articles/s44276-024-00050-0

  The remaining 48 HCC patients (28% of all HCC patients and 2% of the overall cohort) developed HCC without ever passing through the stage of liver cirrhosis as defined by the Fib-4 threshold of 3.25. […] Our results also suggested that liver cirrhosis starts to progress about 14 years before HCC is detected amongst those destined to develop HCC. […] Our findings have major implications for HCC surveillance.

• #2 Hepatic Progression of Hepatocellular Carcinoma | IntechOpen

  https://www.intechopen.com/chapters/82946

  Hypoxia is common to many tumors. In HCC, hypoxia is present and responsible for progression and metastatization. Liver cirrhosis and the rapid growth of the neoplastic nodule determine a reduction in blood flow with the consequent establishment of a hypoxic state. Both liver cirrhosis and tumor size (8 cm) are independent risk factors for development of portal vein tumor thrombi. PVTT is present in 20-70% of HCC and correlates with poor prognosis. […] The process of metastasis is a complex phenomenon that occurs through multiple steps, from intravasation after the escape from the primary tumor, to the overcoming of the systems of recognition and cellular destruction, to the invasion and survival in the blood stream. Cells that manage to overcome these steps have developed a high capacity for metastasis through accumulation of genetic and epigenetic alterations including microRNA (miRNA) expression changes.

• #2 Hepatocellular Carcinoma (HCC): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/197319-overview

  Complications from HCC are those of hepatic failure; death occurs from cachexia, variceal bleeding, or (rarely) tumor rupture and bleeding into the peritoneum. Signs and symptoms of hepatic failure may signify tumor recurrence and/or progression. […] Tumors are multifocal within the liver in 75% of cases. Late in the disease, metastases may develop in the lung, portal vein, periportal nodes, bone, or brain.

• #2 HCC symptoms – Liver Cancer UK

  https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/signs-and-symptoms/

  Early on, you may have few other symptoms from jaundice. Later, it can cause flu-like symptoms, including fever, aching muscles and feeling weak and tired. You may also feel sick. […] Around 1 in 5 people (20%) have odd symptoms caused by the liver tumours making hormones. Doctors call this paraneoplastic syndrome. One in 10 people (10%) have this when they first go to the doctor. The commonest are: […] high blood calcium, causing sickness, weakness and constipation. If not treated, patients become confused and increasingly drowsy […] low blood sugar causing tiredness, weakness and fainting. […] Sadly, in up to 4 out of 10 people (40%) the cancer has already spread before it’s diagnosed. If it has spread to the bones, you may have bone pain or sudden bone fractures for little or no reason. If it spreads to the lungs, it can cause cough and shortness of breath.

• #2 Hepatocellular Carcinoma | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hepatocellular-carcinoma

  Hepatocellular carcinoma traditionally affects children in adolescence and young adulthood. Rarely, it can occur in very young children. […] Different children may experience symptoms differently, and symptoms may vary depending on the size of the tumor and whether the tumor has spread. Your child’s symptoms may include: A large abdominal mass or a swollen abdomen, Pain on the right side that may extend to the back and shoulder, Back pain from compression of the tumor, Decreased appetite and weight loss, Vomiting, Jaundice, Fever, Itching skin, Anemia. […] Hepatocellular carcinoma can spread to the lungs, lymph nodes within the abdomen, the lining of the abdominal cavity, and, rarely, to the bone or brain. […] Patients require both systemic therapy (such as chemotherapy) and local control, or surgery, to achieve cure. Hepatocellular carcinoma is only variably responsive to chemotherapy. […] Surgery may be more difficult for patients with hepatocellular carcinoma, as this type of cancer has often spread by the time it is diagnosed, can involve multiple parts of the liver, and can occur in patients with underlying liver disease.

• #2 Liver cancer (Primary)

  https://www.cancervic.org.au/cancer-information/types-of-cancer/liver_cancer/managing-symptoms.html

  Chronic liver disease may cause toxic substances to build up in the blood, which can affect how your brain functions. Called hepatic encephalopathy, it can lead to confusion or disorientation and, in severe cases, coma. […] For many people with primary liver cancer, the cancer cannot be cured. Talking to your health care team can help you understand your situation and plan for your future care.

• #2 The Truth About Liver Cancer Symptoms and Early Detection – Ezra

  https://ezra.com/blog/liver-cancer-symptoms

  When liver cancer is in its early stages, it may not lead to any symptoms or signs. However, there are a few early symptoms and signs, including: […] Other liver cancer symptoms can include: […] Sometimes, people can have symptoms that seem unrelated to the liver, which can result from a condition called paraneoplastic syndrome. This is when liver cancer cells produce hormones that lead to other problems. This can lead to conditions including: […] For some people whose liver cancer is detected in its early stages, a treatment option may include a liver transplant. Candidates for liver transplant can include those with hepatocellular carcinoma that is localized, meaning it has not yet spread to other parts of the body. […] When it comes to cancer, outcomes are usually better when it is caught early. For liver cancer, its no different. According to the American Cancer Society, while 5-year survival rates for distant or metastasized liver cancer are only 3%, the rates for localized (limited to one area of the liver) are 36%. This shows that early detection is key to optimizing outcomes.

• #2 What is The Last Stage Of Liver Cancer? – Dr Praveen Kammar

  https://drpraveenkammar.com/blogs/what-is-the-last-stage-of-liver-cancer/

  According to the American Cancer Society, the relative 5-year survival rate for liver cancer spread to lymph nodes or other nearby tissues is 11 percent. However, when cancer has spread to the lungs, bones, or other organs, the relative 5-year survival rate is only 2 percent. […] Unfortunately, for the last stage of liver cancer, treatment wont cure it. Instead, it aims to control cancer, relieve symptoms and give you a good quality of life. […] Many patients of liver cancers have damaged liver due to cirrhosis. And sometimes it is the damaged liver that limits the treatment options. […] It may also lead to liver failure. Hence treating and managing the damaged liver is also equally important. Several medicines and interventions are available to limit the progression of liver damage.

• #2 Liver Cancer > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/liver-cancer

  Symptoms include abdominal pain, abdominal swelling, yellowing of the skin and eyes, easy bruising or bleeding, unintentional weight loss […] Symptoms of liver cancer may not occur until the disease has reached an advanced stage. When symptoms are present, they can include: Unintentional weight loss, Loss of appetite or feeling full after eating small meals, Nausea and vomiting, Easy bruising or bleeding, Yellowing of the skin and eyes (known as jaundice), Abdominal pain (especially on the upper right side, where the liver is located), Lump on the right side of the abdomen, Pain in the right shoulder, Abdominal swelling, Ankle swelling, Fatigue, Fever, Itchy skin […] The vast majority of people who develop HCC have cirrhosis. […] There is a lot we can do for patients diagnosed at an early stage, and some patients can be cured.

• #2 Liver Cancer: Symptoms & Prevention | Franciscan Health

  https://www.franciscanhealth.org/community/blog/liver-cancer-symptoms-prevention

  Symptoms of liver cancer can often seem like signs of other conditions. These signs may include: […] Jaundice (yellowing of your skin or eyes) […] Unexplained tiredness […] Up to 60% of liver cancers are only diagnosed in advanced stages, resulting in a survival rate of just 20%.

• #3 Tumor initiation and progression in hepatocellular carcinoma: risk factors, classification, and therapeutic targets | Acta Pharmacologica Sinica

  https://www.nature.com/articles/aps2010142

  Hepatocellular carcinoma (HCC) is a major health problem worldwide responsible for 500 000 deaths annually. A number of risk factors are associated with either the induction of the disease or its progression; these include infection with hepatitis B or C virus, alcohol consumption, non-alcoholic steatohepatitis and certain congenital disorders. […] In around 80% of the cases, HCC is associated with cirrhosis or advanced fibrosis and with inflammation and oxidative stress. […] HCC development is recognized as a multistep process that normally develops over many years. Over this period several mutations accumulate in the cell and that stimulate malign transformation, growth, and metastatic behavior. […] Cirrhosis is associated with the development of HCC, but the molecular basis for the cancer-promoting effect of cirrhosis remains far from clear.

• #3 Can you have liver cancer and not know it? | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancertalk/202010/can-you-have-liver-cancer-not-know-it

  Like most cancers, liver cancer typically develops slowly and quietly, without causing any noticeable symptoms in its early stages. […] Most liver cancer patients wont experience symptoms until later stages of the disease. Symptoms include: Unexpected weight loss, Loss of appetite, Upper abdominal pain, Nausea and vomiting, General weakness and fatigue, Abdominal swelling, Jaundice in skin and whites of eyes. […] Treatment for hepatocellular carcinoma includes surgery, local liver-directed treatments such as radiofrequency ablation, trans-arterial chemoembolization and radioembolization, targeted therapy and immunotherapy. In addition, some patients might be eligible for liver transplantation. […] Patients with cirrhosis should undergo screening for liver cancer for early detection at a stage where curative treatments can be an option.

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