Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review

Abstract

In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure—27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.

Hepatocellular carcinoma directly invaded the stomach at the time of diagnosis

“…3 A systematic review published by Urhut et al in 2022 included 192 patients, 87.3% of whom were male. 1 According to the report, the most common GI tract metastases were in the stomach (27.9%) and duodenum (27.9%). Most routes of metastasis were direct invasion and hematogenous metastasis.…”

“…After diagnosis of GI metastases, the average remaining lifespan is approximately 7.3 months. 1 Sohn et al reported the earliest case of HCC metastasis to the GI tract in 1965. The tumor was approximately of 6 cm, and located in the left hepatic lobe with portal vein invasion, and metastasized to the esophagus.…”

“…Because of their close anatomical location, tumors located on the right side of the liver are more likely to invade the duodenum, whereas tumors located on the left side of the liver are more likely to invade the stomach. 1 Symptoms of HCC with GI invasion include GI bleeding, anemia, abdominal pain, palpable masses, nausea, and vomiting. Esophagogastroduodenoscopy and abdominal contrast-CT are the most useful diagnostic tools.…”