📄 የNCCN የሕሙማን ትምህርት ጽሑፍ

Liver Cancer

Closely linked to hepatitis B and C — prevention and early detection matter

📚 በNCCN የሕሙማን መመሪያዎች® ላይ የተመሠረተ · 🌍 ለኢትዮጵያና ለምሥራቅ አፍሪካ ሁኔታ የተዘጋጀ · 👨‍⚕️ የስለ ካንሰር ቡድን

📖 What Is Liver Cancer?

The liver is the body's largest internal organ, responsible for filtering the blood, producing bile, and carrying out hundreds of metabolic functions. Primary liver cancer begins in the liver itself. The most common type is Hepatocellular Carcinoma (HCC), which starts in hepatocytes (the main liver cells). HCC usually develops against a background of chronic liver disease — cirrhosis caused by chronic Hepatitis B or C infection, alcohol, or fatty liver disease. Secondary (metastatic) liver cancer — cancer that has spread to the liver from another organ — is more common worldwide but is a separate condition.

🔍 Warning Signs & Symptoms

Liver cancer often presents late. Symptoms may include:

  • Right upper abdominal pain or discomfort — a dull ache under the right rib cage
  • Rapid increase in abdominal girth due to fluid accumulation (ascites)
  • Unexplained weight loss and loss of appetite
  • Yellowing of the skin and eyes (jaundice) — when bile ducts are blocked
  • Nausea and vomiting
  • A hard lump felt in the right upper abdomen
  • Extreme fatigue and weakness
  • Fever without obvious cause
  • Individuals with known cirrhosis or Hepatitis B should undergo regular surveillance ultrasound

🩺 Diagnosis

Ultrasound of the liver is the first-line screening tool for at-risk individuals (every 6 months). AFP (Alpha-fetoprotein) blood test — elevated AFP combined with a liver mass strongly suggests HCC, though some HCCs have normal AFP. CT or MRI with contrast: if a liver nodule ≥1 cm shows a characteristic 'wash-in and wash-out' enhancement pattern on dynamic contrast imaging, this is diagnostic of HCC without biopsy. Liver biopsy may be performed for atypical lesions. Assessment of liver function (Child-Pugh or ALBI score) is essential to determine treatment options.

📊 Staging — Barcelona Clinic Liver Cancer (BCLC)

HCC is staged using the Barcelona Clinic Liver Cancer (BCLC) system, which considers tumour size, number of lesions, vascular invasion, liver function, and performance status: Stage 0 (Very early): Single tumour <2 cm — curative treatment possible. Stage A (Early): 1–3 tumours, each <3 cm — surgical resection, transplant, or ablation. Stage B (Intermediate): Large or multinodular HCC — TACE (transarterial chemoembolisation). Stage C (Advanced): Vascular invasion or extrahepatic spread — systemic therapy. Stage D (Terminal): Severe liver failure — palliative/supportive care only.

💊 Treatment Options

NCCN Guidelines recommend:

  • Surgical resection — Removes part of the liver containing the tumour; requires adequate remaining liver function
  • Liver transplantation — Curative for early-stage HCC meeting Milan criteria; limited by donor availability
  • Radiofrequency ablation (RFA) or microwave ablation — Heat destroys small tumours (<3 cm) using a needle
  • TACE (Transarterial Chemoembolisation) — Injects chemotherapy and blocks the blood supply to the tumour
  • Sorafenib or lenvatinib — Oral targeted therapies for advanced HCC not amenable to local treatment
  • Atezolizumab + bevacizumab — First-line immunotherapy combination for advanced HCC (NCCN Category 1)
  • Palliative care — Pain management, ascites drainage, and nutritional support for advanced disease

🛡️ Prevention — Hepatitis B Vaccination Is Key

Hepatitis B vaccination prevents the leading cause of liver cancer. All newborns should receive Hepatitis B vaccine at birth and complete the full 3-dose schedule. Adults at risk (healthcare workers, unvaccinated individuals) should also be vaccinated. Antiviral therapy (tenofovir or entecavir) for chronic Hepatitis B suppresses viral replication and significantly reduces the risk of developing cirrhosis and HCC. Store grain properly to prevent aflatoxin contamination — use sealed containers, dry grain before storage. Avoid excessive alcohol. All patients with cirrhosis should have liver ultrasound every 6 months.

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