HJNO Jul/Aug 2023

54 JUL / AUG 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY INTRODUCTION Hepatocellular carcinoma (HCC) is a pri- mary tumor of the liver that usually develops in the setting of chronic liver disease, particu- larly in patients with cirrhosis due to alcohol use, chronic hepatitis B or C virus (HBV or HCV) infections, or nonalcohol-associated steatohepatitis (NASH). HCC is the world’s fourth leading cause of cancer-related deaths and the most rapidly growing cause of cancer deaths in the U.S. The prognosis of patients with this tumor remains poor, with a five-year survival rate of 18%. It is estimated that in Western countries, fewer than one-third of patients with cirrhosis undergo surveillance for HCC. As a result, many patients have ad- vanced disease at the time of diagnosis. CLINICAL FEATURES Many patients have no symptoms related to the tumor, especially among those who have been undergoing regular surveillance and have HCC detected at an early stage. Cir- rhosis is present in 90% of patients with HCC inWestern countries. Patients with cirrhosis may develop features of liver decompensa- tion (e.g., variceal bleeding or ascites) due to the extension of HCC into the hepatic or portal veins as the initial manifestation of the tumor. Patients with advanced lesions may present with mild to moderate upper abdominal pain, weight loss, early satiety, or a palpable mass in the upper abdomen. Pa- tients with HCC may occasionally develop a paraneoplastic syndrome (hypoglycemia, hypercalcemia, diarrhea, cutaneous features, erythrocytosis) and are generally associated with poor prognoses. The extrahepatic metastases are present at the time of diagnosis in approximately 10 to 15% of cases. The most common sites of extrahepatic metastases are the lung, in- traabdominal lymph nodes, bone, and adre- nal gland, in that order. Brain metastases are rare overall (0.2 to 2%). Hepatocellular Carcinoma