Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver derived from the parenchymal cells. HCC is one of the most frequent cancer types worldwide. Usually (up to 80% of cases) this tumor occurs in individuals who have preceding chronic liver disease and cirrhosis. The disease affects the whole body causing multiple complications including life-threatening.
Hepatic decompensation and parenchymal insufficiency
In most cases, decompensation of liver function is detected when the diagnosis is made. Typical symptoms of liver failure include fluid accumulation in the abdomen, jaundice, and lethargy.
Gastrointestinal bleeding occurs very often in individuals with hepatocellular carcinoma due to portal hypertension and esophageal varices. Increased pressure in the portal vein causes the development of abnormally enlarged veins in the esophagus which may rupture and cause severe gastrointestinal bleeding manifesting with bloody vomiting.
Tumor rupture is the most severe complication of hepatocellular carcinoma. A person experiences acute abdominal pain and tenderness, profuse sweating, dizziness, fainting, etc., although sometimes the rupture may even be asymptomatic.
There are several theories regarding the causes of tumor rupture.
- The artery or vein, which provides the blood supply or drain the tumor may rupture causing the bleeding;
- The superficial tumor may rupture as the result of minor abdominal trauma or any abrupt movement;
- The branches of the hepatic veins become occluded as the tumor grows resulting in the increased pressure within the tumor and leading to its rupture;
The tumor often invades the vessels of the liver – the portal vein and hepatic veins.
Invasion and/or compression of the bile duct may also occur, although are not very common. Obstruction of bile duct leads to the development of jaundice which should be distinguished from jaundice related to liver failure.
Usually, extrahepatic metastases of HCC are detected in the lungs, abdominal lymph nodes, and bones.
The malignancy anywhere in the body may eventually cause the development of systemic effects and symptoms which are related to the impaired body functioning due to the presence of the tumor. These signs are referred to as the paraneoplastic syndromes and include multiple nonspecific features. However, paraneoplastic syndromes develop extremely rare in individuals with HCC.
- Hypoglycemia – low blood glucose levels;
- Erythrocytosis – increased red blood cells count;
- Hypercalcemia – high levels of Calcium in the blood;
- Hypercholesterolemia – increased cholesterol values in the blood;
- Porphyria cutanea tarda – the skin is sensitive to the light;
- Virilization and feminization syndromes – hormonal imbalance lead to the development of gynecomastia in men and amenorrhea in women;
- Carcinoid syndrome – a syndrome which includes flushing and diarrhea, and less frequently, heart failure, emesis, and bronchoconstriction;
- Hypertrophic osteoarthropathy – a condition characterized by the inflammation of the hand joints periosteum;
- Hyperthyroidism – increased values of thyroid hormones in the blood;
- Osteoporosis – decreased bone density and increased risk of fractures;