Hepatocellular carcinoma natural history
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Differentiating Hepatocellular carcinoma from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. If the cancer is inoperable, the disease is usually deadly within 3 to 6 months.
Natural History
Without treatment, the patient will develop symptoms of jaundice, ascites, cachexia, right upper quadrant abdominal pain, nausea, and vomiting, which will eventually lead to death.
Complications
Complications that can develop as a result of hepatocellular carcinoma are:
- Jaundice
- Ascites
- Cachexia
- Coagulopathy
- Erythrocytosis
- Hypercalcemia
- Hypertension
- Watery diarrhea
- Hypoglycemia
- Hypercholesterolemia
The following complications may result from TAE/TACE therapy of the tumour:
- Liver rupture
- Liver abscess
- Femoral artery pseudoaneurysm
- Cholecystitis
- Biloma
- Pulmonary embolism
- Partial intestinal obstruction
Prognosis
Due to its late presentation, the prognosis of hepatocellular carcinoma is poor even with treatment. Without treatment, hepatocellular carcinoma will result in early death. The prognosis depends on the following:
- Operable vs inoperable cancer
- Cancer staging: Size and metastasis play a major role in prognosis
- Patient’s general health
- Time of cancer diagnosis
Independent predictors of prognosis
- The following parameters are known to be independent predictors of prognosis for hepatocellular carcinoma:[1]
- Alpha fetoprotein (AFP)
- Alkaline phosphatase
- International normalized ratio
- Creatinine
- MELD score > 10
- Number of nodules
- Maximum tumor diameter
- Portal vein thrombosis
- Extrahepatic metastasis
- Performance status
Prognosis based on staging systems
- The Barcelona Clinic Liver Cancer (BCLC) staging system has the best independent predictive power for survival when compared with the other 6 prognostic systems.[1]
References