Kathleen E. Corey, MD, MPH, director of the Massachusetts General Hospital Fatty Liver Clinic, and Andrew X. Zhu, MD, PhD, director of hepatobiliary research at the Mass General Cancer Center, offer advice to physicians for diagnosing and treating patients with suspected hepatocellular carcinoma (HCC).
Diagnosing Hepatocellular Carcinoma (HCC)
How often should patients with cirrhosis be screened for hepatocellular carcinoma (HCC)?
The American Association for the Study of Liver Disease (AASLD) recommends that patients with cirrhosis be screened with ultrasound or other imaging modalities every six months indefinitely.
Can HCC occur in patients without cirrhosis?
Yes. While HCC is most commonly diagnosed in patients with cirrhosis, which is often caused by chronic hepatitis C or alcohol abuse, it can occur in patients without cirrhosis. Patients with chronic hepatitis B and nonalcoholic steatohepatitis (NASH), with or without cirrhosis, are at risk for developing HCC.
In addition, an HCC variant, called fibrolamellar HCC (FL-HCC), occurs most commonly in young patients without preexisting liver disease and accounts for 1% of all cases of HCC. Unfortunately, there are no recommended screening protocols to detect NASH-related HCC or FL-HCC early.
Treatment Options for HCC
Can patients with cirrhosis and HCC still receive a liver transplant?
Yes. For patients with HCC that meet the Milan criteria (a single lesion that is ≥ 2 cm and ≤ 5 cm, or three or more lesions that are ≥ 1cm and ≤ 3 cm each), liver transplantation can be a curative option for HCC. Transplantation not only treats HCC, but also removes the liver, which is at risk for the development of additional lesions.
Another treatment option is surgical resection. For patients who are not a transplant or resection candidate, the Mass General Cancer Center offers:
- Radiofrequency and microwave ablation
- Transarterial chemoembolization
- Proton beam therapy
- Chemotherapeutic and targeted agents.