Dawaa Reference

Clinical reference

Liver Cancer (Hepatocellular Carcinoma)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Hepatocellular Carcinoma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559177/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD28.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Liver Cancer (Hepatocellular Carcinoma) - disease-level clinical article (liver-cancer-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Non-cirrhotic disease can be silent early on
  • In cirrhotic patients, worsening jaundice, itching, confusion, fluid swelling of the belly, an upper-abdominal lump, fever, malaise, weight loss, early fullness, bloating, and wasting can occur [abdominal distension · cirrhosis · confusion · fever · itching · jaundice · malaise · muscle wasting · weight loss]
  • Abdominal pain is the single most common symptom [abdominal pain]
  • A paraneoplastic syndrome can cause low blood sugar, excess red cells, high calcium, diarrhoea, and skin findings such as pemphigus foliaceus, pityriasis rotunda, dermatomyositis, and the Leser-Trelat sign [diarrhoea · hypoglycaemia]
  • Some patients present acutely with variceal bleeding, bleeding into the abdomen, obstructive jaundice, a pus-filled liver abscess, or confusion from liver failure [abscess · bleeding · confusion · jaundice · pus]

Signs — what you find (2)

  • A palpable lump in the upper abdomen can be felt in decompensated cirrhotic disease [cirrhosis · skin nodule]
  • The most common sites of spread beyond the liver are the lung, abdominal lymph nodes, bone, and adrenal gland, in that order

Tests (12)

  • Liver enzymes (bilirubin, ALT, AST, ALP) and albumin can be deranged, reflecting disease severity
  • Reduced liver synthetic function shows as a raised INR/prothrombin time, low platelets, anaemia, low sodium, or low blood sugar
  • AFP is raised in advanced disease but does not track with tumour size, and about 40% of small tumours do not secrete it
  • AFP sensitivity is about 66% and specificity is 80% using a threshold of 10.9 ng/mL
  • An AFP over 200 ng/mL is highly specific, though only moderately sensitive, for HCC
  • In patients with known liver disease, an AFP cut-off of 500 ng/mL gives over 90% specificity
  • Ultrasound surveillance sensitivity ranges 51-87% and specificity 80-100%
  • Ultrasound is poor at detecting tumours smaller than 2 cm
  • Contrast-enhanced ultrasound is over 97% specific and about 90% sensitive for confirming a lesion seen on plain ultrasound
  • Triphasic CT is about 65% sensitive and 96% specific per lesion overall, dropping to 40% sensitivity for lesions under 2 cm
  • MRI is roughly 77-90% sensitive and 84-97% specific with contrast
  • Liver biopsy is not routinely done because of a risk of tumour seeding, bleeding, and false negatives; sensitivity is 66-93% and specificity 100%

If not this — what else fits (7)

  • On Doppler ultrasound, HCC classically shows fine branching vessels with brisk flow, unlike a haemangioma or a liver metastasis
  • Regenerative nodules appear iso- or hypoechoic against the surrounding liver, unlike the hypervascular arterial enhancement and washout seen in HCC
  • Cholangiocarcinoma tends to show both arterial and delayed-phase enhancement on multiphasic CT
  • Focal nodular hyperplasia
  • A hepatic adenoma
  • Primary hepatic lymphoma
  • Metastatic cancer to the liver

SourceStatPearls "Hepatocellular Carcinoma" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Hepatocellular carcinoma is common in Egypt because of the country's very high historic hepatitis C burden and resulting cirrhosis. GP recognises the diagnosis in an at-risk (cirrhotic or HCV-positive) patient, manages symptoms such as ascites, and refers urgently to hepatology/oncology. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Hepatocellular carcinoma is common in Egypt because of the country's very high historic hepatitis C burden and resulting cirrhosis. GP recognises the diagnosis in an at-risk (cirrhotic or HCV-positive) patient, manages symptoms such as ascites, and refers urgently to hepatology/oncology.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Intraperitoneal bleeding is a life-threatening complication of HCC presenting with worsening abdominal girth, pain, hypotension, and anemia requiring emergency intervention.
  • RED FLAG - Rapid abdominal swelling, new jaundice, confusion (possible hepatic encephalopathy), or unexplained weight loss in a patient with known cirrhosis or hepatitis C.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.