Hepatocellular Carcinoma (HCC) Clinical Presentation

Updated: Nov 25, 2019
  • Author: Luca Cicalese, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History

Patients with hepatocellular carcinoma (HCC) generally present with signs and symptoms of advancing cirrhosis, as follows:

  • Jaundice
  • Variceal bleeding
  • Cachexia
  • Increasing abdominal girth (portal vein occlusion by thrombus with rapid development of ascites)
  • Right upper quadrant pain (uncommon)
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Physical Examination

Physical examination findings may include the following:

  • Jaundice
  • Ascites
  • Hepatomegaly
  • Alcoholic stigmata (Dupuytren contracture, spider angiomata)
  • Asterixis
  • Pedal edema
  • Periumbilical collateral veins
  • Enlarged hemorrhoidal veins
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Complications

Complications from HCC are those of hepatic failure; death occurs from cachexia, variceal bleeding, or (rarely) tumor rupture and bleeding into the peritoneum. Signs and symptoms of hepatic failure may signify tumor recurrence and/or progression.

Various studies have reported extrahepatic metastasis in up to 30–50% of cases of HCC, with lungs the commonest site, followed by lymph nodes and bones. Unusual extrahepatic metastatic sites include the following [30] :

  • Adrenal glands
  • Peritoneum
  • Diaphragm
  • Soft tissues
  • Brain
  • Skin
  • Oral cavity
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