Primary hepatocellular carcinoma is classified pathologically and includes mainly hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and mixed hepatocellular-intrahepatic cholangiocarcinoma.
What is hepatocellular carcinoma?
Hepatocellular carcinoma (HCC) is a malignant tumor of the liver that originates in hepatocytes, and what we commonly refer to as hepatocellular carcinoma is primarily hepatocellular carcinoma.
Risk factors for hepatocellular carcinoma
China has the highest incidence and mortality rate of hepatocellular carcinoma in the world. In China, the incidence of hepatocellular carcinoma is mainly associated with hepatitis B virus infection. In Western countries and Japan, the incidence of hepatocellular carcinoma is associated with hepatitis C virus, alcoholic liver disease, and nonalcoholic fatty liver disease.
Clinical manifestations of hepatocellular carcinoma
Hepatocellular carcinoma is pathologically classified into giant, nodular, and diffuse types.
Patients with early-stage hepatocellular carcinoma often have no clinical symptoms, and patients with advanced stage will show symptoms such as liver pain and weakness, wasting, fever, and cachexia. Serologic testing may show elevated methemoglobin, with a positive rate of about 70%.
Treatment of hepatocellular carcinoma
Treatment for hepatocellular carcinoma includes surgical resection, radiofrequency ablation, hepatic artery chemoembolization, anhydrous alcohol injection, radiotherapy, and targeted therapy.
Prognosis of hepatocellular carcinoma
The prognosis is better for small hepatocellular carcinoma detected early and worse for advanced hepatocellular carcinoma. Therefore, regular medical checkups for high-risk groups (hepatitis B surface antigen carriers) and early diagnosis and treatment can improve the prognosis of patients with hepatocellular carcinoma.
What is intrahepatic cholangiocarcinoma?
Intrahepatic cholangiocarcinoma (ICC), a malignant tumor that occurs in the epithelial cells of the secondary branching bile ducts as well as the distal intrahepatic bile ducts, is much less common than hepatocellular liver cancer and accounts for about 5% of primary liver cancers.
Risk factors for intrahepatic cholangiocarcinoma
The development of intrahepatic cholangiocarcinoma is associated with the following factors:
- Chronic inflammation and infection of the biliary tract;
- Biliary duct and gallbladder stones:
- Hepatitis virus infection;
- Cystic malformations of the bile ducts (congenital bile duct dilatation);
- Hepatic schistosome (Schistosoma chinense) infection;
- History of biliary surgery;
- Ulcerative colitis;
- Sclerosing cholangitis with malignant transformation.
Clinical manifestations of intrahepatic cholangiocarcinoma
Based on the morphology of the tumor, intrahepatic cholangiocarcinoma is divided into three basic types: mass type, periductal infiltrative type, and intraductal growth type.
The clinical symptoms of patients vary depending on the site of occurrence. Patients with cholangiocarcinoma starting in the terminal type have no symptoms in the early stage, and in the late stage, they may have upper abdominal discomfort, pain in the liver area, weight loss, etc. Cholangiocarcinoma occurring in the hilar region often has jaundice as the starting symptom.
Serological tests can reveal elevated jaundice, and about 50% to 60% of patients have elevated tumor markers CEA and CA19-9.
Treatment of intrahepatic cholangiocarcinoma
Treatment of cholangiocarcinoma includes surgical resection, systemic chemotherapy, radiation therapy, and hepatic artery chemoembolization.
Prognosis of intrahepatic cholangiocarcinoma
The overall prognosis is worse than that of hepatocellular carcinoma because cholangiocarcinoma is insensitive to both chemotherapy and radiotherapy.