Hepatocellular carcinoma

Malignant liver tumor, or hepatocellular carcinoma: detection and risk factors

Hepatocellular carcinoma ranks second among the causes of death in men from malignant neoplasms. The first place belongs to lung cancer. This disease is not rare, but it is diagnosed, unfortunately, like most oncological diseases in Ukraine, mostly at the III-IV stage of the disease. The reasons for advanced forms of hepatocellular carcinoma are the late appearance of organ-specific symptoms. Weakness, problems with digestion, decreased appetite often lead to self-medication with symptomatic means and a late visit to the doctor. The only reliable method to detect hepatocellular carcinoma is a screening MRI examination of the liver.

Risk factors for the development of hepatocellular carcinoma:

Chronic viral hepatitis B is a risk factor for the development of 50% of all cases of hepatocellular carcinoma among all age groups and the majority of cases of hepatocellular carcinoma in children.

Chronic viral hepatitis C. For example, in Japan, markers of chronic viral hepatitis C are found in 80-90% of patients with hepatocellular carcinoma.

Cirrhosis of the liver, which develops as a result of the following diseases:

• alcoholic liver disease;

• non-alcoholic steatohepatitis;

• primary biliary cirrhosis;

• hemochromatosis;

• deficiency of α1-antitrypsin;

• autoimmune hepatitis.

The effect of aflatoxins, highly toxic carcinogens produced by various species of microscopic fungi representing several species of the genus Aspergillus, mainly fungi of the species A. flavus and A. parasiticus, which grow on the grains, seeds and fruits of plants with a high oil content, such as peanuts.

Adiposity.

Diabetes.

Prognosis: The five-year survival rate for hepatocellular carcinoma is only 18%.

The "Oberig" clinic has accumulated a huge experience of successfully helping patients with hepatocellular carcinoma. The LiverLab diagnostic complex — the most modern software installed on the latest generation MRI machine, allows not only to establish the exact localization of the tumor, but also to recognize a malignant neoplasm with high reliability.

The team of the Center for Pancreatic Surgery and Transplantation of the universal clinic "Oberig" (Kyiv), headed by Oleg Gennadiyovych Kotenko - Doctor of Medical Sciences, professor, leading Ukrainian oncologist, transplant doctor, laureate of the State Prize of Ukraine in the field of science and technology (2008 ). — in charge of your health. Apply!

Hepatocellular carcinoma: classification, stages

Hepatocellular carcinoma is a primary malignant tumor of the liver. Hepatocellular carcinoma is the fifth most common malignancy worldwide.

Hepatocellular carcinoma is diagnosed in more than 90% of all primary liver tumors.

Hepatocellular carcinoma is diagnosed in almost 85% of patients with liver cirrhosis.

In men, after lung cancer, hepatocellular carcinoma is the second leading cause of cancer-related death.

TNM classification of hepatocellular carcinoma

The TNM classification system takes into account such characteristics of the tumor as its size, the number of tumors, the presence or absence of vascular invasion (tumor growth into blood vessels), as well as the involvement of lymph nodes and metastasis.

T is a primary tumor.

Tx — the primary tumor cannot be evaluated.

T0 - there are no signs of a primary tumor.

T1a is a solitary tumor 2 cm or less in greatest dimension with or without vascular invasion.

T1b — a solitary tumor larger than 2 cm in the largest dimension without vascular invasion.

T2 — solitary tumor larger than 2 cm with vascular invasion; or multiple tumors, none larger than 5 cm in greatest dimension.

T3 — multiple tumors, at least one or more of them larger than 5 cm in the largest dimension.

T4 — tumors with involvement of the main branch of the portal vein or hepatic vein or with direct invasion of neighboring organs, including the diaphragm, except for the gall bladder, or with perforation of the visceral leaf of the peritoneum.

N — regional lymph nodes

Nx — regional lymph nodes cannot be evaluated.

N0 — metastasis to regional lymph nodes is absent.

N1 is a metastasis in a regional lymph node.

M is distant metastasis

M0 — no distant metastasis

M1 — distant metastasis is present.

Stages of the tumor process

Hepatocellular carcinoma is a fairly common liver cancer with a low survival rate without proper treatment, especially surgery, including liver transplantation.
Establishing an accurate diagnosis, developing a detailed plan for examination, treatment and prognosis of long-term consequences in hepatocellular carcinoma requires highly qualified and highly specialized medical care, which can be provided by specialists from the Center for Pancreatic Surgery and Transplantation of the Oberig Universal Clinic. under the guidance of the leading Ukrainian surgeon, oncosurgeon, transplant doctor, MD, prof. Kotenko Oleg Gennadievich

Methods of diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma is a terrible disease that has an oncological nature and, unfortunately, is quite common. Despite the prevalence, often non-specific symptoms do not become a reason for a thorough examination, so the disease does not manifest itself in the earliest stages. Usually, patients with hepatocellular carcinoma seek specialized help when symptoms such as jaundice, abdominal pain, abdominal enlargement and/or swelling, and unmotivated weight loss occur.


In order to establish the diagnosis and its confirmation, the following laboratory-instrumental diagnostic examinations should be performed when hepatocellular carcinoma is suspected:

- measurement of alpha-fetoprotein level in blood serum;
- different instrumental methods of liver imaging: ultrasound examination (US), computer tomography (CT), magnetic resonance imaging (MRI).
- an additional method is a liver biopsy


In 40-65% of adult patients with hepatocellular carcinoma, the level of alpha-fetoprotein in blood serum exceeds 400 ng/ml (400 μg/l). This level is high and most specific for hepatocellular carcinoma.

Ultrasound of the liver is used for screening, diagnosis of hepatocellular carcinoma and dynamic monitoring of the state of the liver.

The sensitivity and specificity of ultrasound of the liver fluctuate between 51-87% and 80-100%, respectively.

With the help of this study, without the introduction of a contrast agent into the vascular bed (contrast), the size, morphology, localization, vascular invasion (tumor growth into the vessels) of hepatocellular carcinoma are determined.

This disease is characterized by an increase in blood flow to tumors and the appearance of new blood vessels.

For tumors less than 2 cm in size, the use of ultrasound for the diagnosis of hepatocellular carcinoma is limited.

Ultrasound of the liver with the introduction of a contrast agent is used to clarify the characteristics of a tumor diagnosed with the help of ultrasound without contrast.

In order to monitor the survival of high-risk patients with hepatocellular carcinoma, every 6 months it is necessary to conduct a liver examination with the help of ultrasound in combination with determining the level of alpha-fetoprotein in the blood serum or without it.

CT. Diagnostic criteria of hepatocellular carcinoma when performing a three-phase CT scan include hyperintensification of the signal in the arterial phase and rapid washout in the aortic-venous (portal) phase compared with a normal tomographic picture of healthy liver tissue (hepatic background).

The sensitivity and specificity of three-phase CT is 65% and 96%, respectively.

The sensitivity of three-phase CT decreases to 40% in the presence of tumors less than 2 cm in size.

The positive prognostic value increases to 92% for tumors 2 cm and larger.

MRI. T1-weighted images obtained by the MRI method demonstrate to the doctor the anatomy of normal organs and the presence of fat in tissues, and T2-weighted images show fluids and abnormalities of tissues and organs (for example, tumors, inflammation, trauma).

T1-weighted images of the liver can be both isointense and hyperintense, depending on the degree of liver fibrosis, the amount of fat and/or necrosis. Hyperintense images on T1 are mostly highly differentiated tumors and they look like isointense on T2 images.

Low-differentiated and moderately differentiated tumors are isointense on T1-images and hyperintense on T2-images.

The sensitivity of contrast-enhanced MRI is 77-90%, and the specificity is 84-97%.

Liver biopsy. Percutaneous biopsy under the control of ultrasound or CT is performed in the event that with the help of instrumental methods of visualization of the liver, changes atypical for hepatocellular carcinoma are detected or in the absence of cirrhosis of the liver.

In case of a negative liver biopsy result, i.e. the absence of signs of hepatocellular carcinoma in the tissue sample, the doctor performs a repeat biopsy every 3-6 months, until the neoplasm begins to be visualized, increases in size, or other diagnostic signs of this disease appear.

Symptoms and signs of hepatocellular carcinoma are quite non-specific, therefore establishing an accurate diagnosis, developing a detailed examination plan, and diagnosing hepatocellular carcinoma requires highly qualified and highly specialized assistance, which can be provided by the specialists of the Center for Pancreatic Surgery and Transplantation. under the guidance of a leading Ukrainian oncologist, transplant physician, surgeon, doctor of medicine, prof. Oleg Gennadyevich's kitten.

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