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Clinical features and diagnosis of primary hepatocellular carcinoma

Jonathan M Schwartz, MD
Robert L Carithers, Jr, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editors
Anne C Travis, MD, MSc, FACG, AGAF
Diane MF Savarese, MD


Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in patients with chronic hepatitis B and C. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

The diagnosis of HCC can be difficult and often requires the use of one or more imaging modalities [1,2]. Ideally, tumors should be detected when they are approximately 2 cm in size so that all treatment options can be offered. However, HCC is frequently diagnosed late in its course because of the absence of pathognomonic symptoms [3,4]. As a result, many patients have untreatable disease when first diagnosed. The median survival following diagnosis is approximately 6 to 20 months [5]. Large tumor size, vascular invasion, poor functional status, and nodal metastases are all associated with a poor outcome [6,7].

This topic review will discuss the clinical and histologic features of HCC, and the various modalities used to diagnose and stage this aggressive tumor. The controversial topic of screening populations at risk for HCC will also be discussed. An overview of treatment for this tumor is presented separately. (See "Overview of treatment approaches for hepatocellular carcinoma".)


Patients who develop hepatocellular carcinoma (HCC) usually have no symptoms other than those related to their chronic liver disease. Suspicion for HCC should be heightened in patients with previously compensated cirrhosis who develop decompensation such as ascites, encephalopathy, jaundice, or variceal bleeding. These complications are often associated with extension of the tumor into the hepatic or portal veins or arteriovenous shunting induced by the tumor [8].

Some patients may have mild to moderate upper abdominal pain, weight loss, early satiety, or a palpable mass in the upper abdomen. These symptoms often indicate an advanced lesion [3]. Other uncommon presentations include:

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