Hepatocellular Carcinoma. Part 2: Clinical Presentation and Diagnosis

Abstract

Clinical presentation of hepatocellular carcinoma (HCC) can vary from asymptomatic patients to patients presenting variable symptoms such as pain, lethargy, jaundice, hepatic encephalopathy, anasarca, ascites, variceal bleeding, diarrhoea, paraneoplastic symptoms, cutaneous manifestations, and abnormal laboratory values. Diagnosis of HCC is based on computed tomography (CT), magnetic resonance imaging (MRI), and tumour markers. The most commonly used is alpha fetoprotein.1,2 MRI is the imaging method of choice, although it has decreased sensitivity in detecting lesions <2 cm.3 Other possibilities include biomarkers such as embryonic antigen, protein antigen, enzymes and isoenzymes, cytokines, and genetic biomarkers. Liver biopsy is used in selected patients who do not present typical features of HCC on CT or MRI. Surveillance by ultrasound is recommended every 6 months in cirrhotic patients. The Barcelona Clinic Liver Cancer (BCLC) scoring system has been proposed for staging of HCC, and numerous scoring systems have been developed to evaluate progression and determine treatment possibilities; they take into account the clinical as well as the laboratory and pathological criteria, biomarkers, biopsy, and imaging methods.