LIVER CANCER

Pathophysiology

Hepatocellular carcinoma (HCC) is a malignant tumor of hepatocellular origin that

develops in patients with risk factors such as alcohol abuse, viral hepatitis, and
metabolic liver disease. It can also occur, rarely, in patients with normal liver
parenchyma.2

Grossly, HCC can undergo hemorrhage and necrosis because of a lack of fibrous
stroma. Vascular invasion, particularly of the portal system, is common. Invasion of the
biliary system is less common. Aggressive HCC can cause hepatic rupture and
hemoperitoneum.

There are 3 growth patterns exhibited by HCC:

• Solitary mass - Often large

• Multifocal or nodular pattern - Multiple nodules
• Diffuse - Multiple, small foci scattered diffusely throughout the liver

Microscopically, HCC cells resemble normal hepatocytes and can be confused with
cells of hepatic adenoma. Tumors that are more differentiated can produce bile.

HCC can produce alpha-fetoprotein (AFP) as well as other serum proteins.