Hepatocellular carcinoma commonly develops in people with chronic hepatitis B and hepatitis C infections. In the majority of cases (nearly 80%), hepatocellular carcinoma develops following liver cirrhosis caused by these infections or chronic alcoholism.

Liver cancer does not usually present with symptoms until the disease has progressed to an advanced stage and spread to the extent that it can no longer be destroyed with therapy. This means that only around one in five people with this form of cancer live for at least a year after their diagnosis and only one in 20 survive for five years. However, because hepatocellular carcinoma is known to occur in individuals with chronic hepatitis B or hepatitis C, these patients are monitored on a regular basis. The tests used to monitor these high risk individuals are described below.

• Whole abdomen ultrasound scan is a non-invasive and cost-effective test that uses high-frequency sound waves to create an image of the liver so that any abnormalities can be detected.
• Blood tests that indicate raised alpha-fetoprotein and des-gamma carboxyprothrombin levels, show that a patient is at a particularly high risk of developing hepatocellular carcinoma.
• These high risk patients may be advised to have a computed tomography (CT) scan of the abdomen using intravenous contrast agent. The CT scan is performed in three phases including pre-contrast application, immediately after contrast administration, and again at a later stage. This can help locate small tumors and those that are difficult to detect. If cancer is present, the CT scan typically reveals three distinct growth patterns of the cancer, which occurs as a single, large tumor, multiple tumors or poorly defined tumors with an infiltrative growth pattern. The contrasts used are usually iodine or barium. An alternative to CT imaging is magnetic resonance imaging (MRI).
• To confirm a diagnosis of cancer, a biopsy of the tumor tissue is sometimes performed. The tumor tissue is then examined under a microscope to assess its architectural and cytological type. The four main types of hepatocellular cancer include:
  • Fibrolamellar
  • Pseudoglandular (adenoid)
  • Pleomorphic (giant cell)
  • Clear cell