Clinical features

The clinical manifestations are seldom characteristic and are often masked by those related to the background of cirrhosis or chronic hepatitis. HCC should be suspected if a patient with cirrhosis deteriorates without obvious reason or if ascites fails to resolve despite adequate treatment.

Hepatocellular carcinoma is three times more common in males.

Clinical effects of the primary disease include:

• general - malaise, fatigue
• gastrointestinal - anorexia, jaundice, constipation, ill-defined upper abdominal pain, abdominal fullness, bleeding oesophageal varices
• hepatomegaly - liver is often irregular or nodular, and may be tender
• ascites
• dyspnoea - a late finding; may indicate diaphragmatic involvement or compression, or pulmonary metastases

Effects of metastases include:

• pulmonary - pulmonary embolus, pleural effusion
• bone - pain
• brain - confusion, raised intracranial pressure
• lymphadenopathy - particularly, enlargement of right supra-clavicular lymph glands

Systemic effects are rarely florid in HCC. Paraneoplastic syndromes include:

• gynaecomastia - increased secretion of oestrogen
• hypercalcaemia - secretion of parathormone-like hormone
• hypoglycaemia - glucose demand from tumour mass
• hyperthyroidism - inappropriate TSH production