Hepatocellular Carcinoma Evaluation and Management for Physicians- Guidelines released

Hepatocellular carcinoma is often asymptomatic in early stages, and the advent of symptoms may be ominous. The triad of right upper quadrant pain, palpable mass and weight loss may be seen in symptomatic patients. Abdominal distention and abdominal pain were the more common symptoms according to different series and new onset of such symptoms in a chronic liver disease should raise suspicion.

 Guidelines stated that

Early detection of hepatocellular carcinoma is associated with better outcomes. Attempts should be made to diagnose hepatocellular carcinoma in the asymptomatic phase during surveillance.

Hepatocellular carcinoma should be suspected in patients with acute decompensation of cirrhosis, sudden deterioration of liver biochemistry, new onset right hypochondriac discomfort in a cirrhotic, new onset ascites or worsening of ascites, acute variceal bleed and appearance or increasing size of any new lesion on imaging in a cirrhotic.

Hepatocellular carcinoma is associated with very poor prognosis except for the subgroup of the patients who are diagnosed at an early stage and hence, are amenable to curative therapy in the form of resection, ablation or liver transplantation. However, majority of the patients are diagnosed at a later stage in India precluding use of curative therapy. Hence, there is a need for active surveillance of patients at risk to diagnose Hepatocellular carcinoma at an early stage which will translate to reduction in disease-related mortality.

Surveillance of Hepatocellular carcinoma helps in detection of the tumor at an early stage and helps in timely intervention to reduce to mortality and this is a new hope in managing cancer.