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A special form of HCC called ''fibrolamellar HCC'' is very rare. Only 200 new cases are diagnosed every year. This type of HCC develops in young adults without cirrhosis or other risk factors for HCC.
A special form of HCC called ''fibrolamellar HCC'' is very rare. Only 200 new cases are diagnosed every year. This type of HCC develops in young adults without cirrhosis or other risk factors for HCC.
== Clinical features ==
The tumour itself is usually asymptomatic, but the patient usually has symptoms from the underlying disease ([[cirrhosis]] or [[hepatitis]]), like [[ascites]] and [[jaundice]]. [[Constitutional cancer symptom|Constitutional cancer symptoms]] like weight loss, weakness, abdominal pain may be present but may also be caused by the underlying disease.<section begin="radiology" />
== Diagnosis and evaluation ==
Patients at high risk for <abbr>HCC</abbr> (cirrhosis of any cause, chronic hep B) should be screened regularly for HCC. Screening involves measuring abdominal [[ultrasound]] and [[AFP]] levels. Focal lesions in a cirrhotic liver are primary liver cancer until proven otherwise. AFP is elevated only in 50% of cases, in which case the level correlates with the tumour size.


Contrast [[CT]] or [[MR]] confirms the diagnosis and shows any extrahepatic spread. Typical features on imaging include early contrast uptake, “washout”, and vascular spread.<section end="radiology" />
[[Liver biopsy]] is often not needed as the definitive diagnosis can be made with imaging, and biopsy carries a risk of bleeding and tumour spread.
=== Staging ===
=== Staging ===
The Barcelona Clinic Liver Cancer (BCLC) staging is the most frequently used staging system, and at least the one preferred in POTE. The Child-Pugh score and ECOG are important in determining the BCLC stage.
The Barcelona Clinic Liver Cancer (BCLC) staging is the most frequently used staging system, and at least the one preferred in POTE. The Child-Pugh score and ECOG are important in determining the BCLC stage.
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The so-called ''Milan criteria'' are used to evaluate whether the patient is a candidate for liver transplant or not. The Milan criteria are fulfilled if there is either a single tumour not > 5 cm, or up to 3 tumours, none of which are > 3 cm. There must also be no vascular invasion or extrahepatic spread.
The so-called ''Milan criteria'' are used to evaluate whether the patient is a candidate for liver transplant or not. The Milan criteria are fulfilled if there is either a single tumour not > 5 cm, or up to 3 tumours, none of which are > 3 cm. There must also be no vascular invasion or extrahepatic spread.
== Clinical features ==
The tumour itself is usually asymptomatic, but the patient usually has symptoms from the underlying disease ([[cirrhosis]] or [[hepatitis]]), like [[ascites]] and [[jaundice]]. [[Constitutional cancer symptom|Constitutional cancer symptoms]] like weight loss, weakness, abdominal pain may be present but may also be caused by the underlying disease.<section begin="radiology" />
== Diagnosis and evaluation ==
Patients at high risk for <abbr>HCC</abbr> (cirrhosis of any cause, chronic hep B) should be screened regularly for HCC. Screening involves measuring abdominal [[ultrasound]] and [[AFP]] levels. Focal lesions in a cirrhotic liver are primary liver cancer until proven otherwise. AFP is elevated only in 50% of cases, in which case the level correlates with the tumour size.
Contrast [[CT]] or [[MR]] confirms the diagnosis and shows any extrahepatic spread. Typical features on imaging include early contrast uptake, “washout”, and vascular spread.<section end="radiology" />
[[Liver biopsy]] is often not needed as the definitive diagnosis can be made with imaging, and biopsy carries a risk of bleeding and tumour spread.
== Treatment ==
== Treatment ==
[[File:Treatment of HCC.gif|thumb|Treatment of HCC.<ref>https://abdominalkey.com/liver-transplantation-for-hcc-the-milan-criteria/</ref>]]
[[File:Treatment of HCC.gif|thumb|Treatment of HCC.<ref>https://abdominalkey.com/liver-transplantation-for-hcc-the-milan-criteria/</ref>]]