# Liver Cancer (Hepatocellular Carcinoma) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Liver Cancer (Hepatocellular Carcinoma) - disease-level clinical article (liver-cancer-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text LIVER CANCER (HEPATOCELLULAR CARCINOMA) 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 Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Liver Cancer (Hepatocellular Carcinoma) - disease-level clinical article (liver-cancer-clinical.txt) (2026-08) 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 Source StatPearls "Hepatocellular Carcinoma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)