Hepatocellular Carcinoma: Definition

A vast range of liver malignancies can be diagnosed and treated at Mount Sinai. Hepatocellular carcinoma (HCC) is the term for primary liver cancer, or cancer that originates in the liver. Although it is the third most prevalent cause of cancer-related mortality globally, it is the sixth most common kind of cancer overall. Almost invariably, individuals with long-standing liver illness get HCC. Hepatitis C virus infection is the most frequent cause of liver cancer in the US.

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Hepatitis C has historically been a factor in around half of our Mount Sinai HCC patients. Since the introduction of effective therapy for hepatitis C in 2014, this number has been significantly declining. Nonetheless, alcoholic liver disease-related HCC is increasing in frequency. The rise in fatty liver disease is much more noteworthy. This is a result of the growing numbers of diabetes and obesity. Nonalcoholic steatohepatitis is the name of the disorder that is quickly rising to the top as a cause of HCC. On the outskirts of Harlem is where you may find Mount Sinai Hospital. The incidence of liver cancer in Harlem is around 20 incidences per 100,000 persons, largely due to high rates of fatty liver disease, alcohol misuse, and hepatitis C.

Hepatitis B virus is the primary cause of liver cancer worldwide. In China, the prevalence of hepatitis B is around 7%. Over a million people who were born in Asia live in New York metropolis, the most ethnically diverse metropolis in the US. Of these one million persons, around 15% have hepatitis B. Asian patients make up roughly 25% of our HCC patients at Mount Sinai.

The majority of patients with HCC have cirrhosis, a condition where scar tissue accumulates as a result of years of liver injury. If HCC is detected early enough, it can typically be treated since it normally develops slowly in its early stages.

Examining

Individuals who have cirrhosis of any kind have the risk of becoming HCC. It has been shown that doing scans every six months can save lives. Even though ultrasonography screening is widely accessible and reasonably priced, research has shown that up to 30% of early malignancies may go undetected. At Mount Sinai, we thus favor the use of more sensitive techniques such as magnetic resonance imaging or computed tomography.

Identification

Most cancers are diagnosed by having a biopsy, or taking a sample of tissue and examining it under a microscope. However, this isn’t necessarily required for HCC. To make a diagnosis, we can often employ magnetic resonance imaging scans with dye injection or computed tomography. We can detect HCC in a cirrhosis patient if there is a tumor in the liver with a very abundant blood supply. However, sometimes a biopsy is still necessary. Additionally, biopsies are used for genetic analysis, which may be required to create individualized therapy regimens.

Setting Up

We use a process known as “staging the cancer” to assess the extent of your disease and develop the best course of action. We follow the American Joint Commission on Cancer recommendations for the majority of cancer types. However, we employ the Barcelona Clinic Liver Cancer Staging System for liver cancer. Developed by Josep Llovet, MD, director of liver cancer research at Mount Sinai, and colleagues, this method is utilized in Europe and the United States. The four classifications of liver cancer, tumor size, and estimated survival are shown in the chart below.

Options for Treatment

When treating HCC, our objective is to get rid of the tumor or eliminate it before it becomes bigger and starts to spread to other organs. Certain cancer-fighting therapies may be detrimental to liver health; this can be particularly problematic if you also have cirrhosis. The best course of action differs depending on the individual. At Mount Sinai, creating a customized treatment plan for you is done in a collaborative effort.

Surgical resection: We can often remove the portion of the liver that contains the tumor if you have one tumor and normal liver function. The liver grows back, or regenerates, after about six weeks.

Liver transplantation: We might not be able to remove merely a portion of your liver if it is not functioning regularly. The best solution in this situation is frequently a transplant. Priority placement on the liver transplant waiting list is available to patients with early-stage HCC who are unable to undergo resection. You may have to wait over a year for a donor liver, even with priority. We employ nonsurgical therapies to manage the malignancy while you wait. Furthermore, patients who have a competent and willing donor can see a significant reduction in waiting times thanks to Mount Sinai’s living-donor program.

Locoregional therapy: With these nonsurgical techniques, we may frequently eradicate tumors with a diameter of less than three centimeters and regulate the growth of bigger tumors that cannot be surgically removed:

Thermal ablation involves heating the tumor with microwaves using a specialized needle.

Chemoembolization is the process of infusing chemotherapy-containing beads into the blood vessel supplying the tumor.

Injecting radioactive beads into the tumor’s blood supply is known as radioembolization.

stereotactic body radiotherapy, which targets the tumor with high radiation dosages

Systemic therapy: Patients with class C HCC had a year or more to live following diagnosis, up until a few years ago. HCC patients do not respond well to traditional chemotherapy, but novel medications known as targeted therapies have been shown to extend survival by halting the cancer’s growth, sometimes for many months.

Immunotherapy’s progress is much more promising. The purpose of our immune system is to recognize and eliminate cancerous cells. Checkpoints, sometimes known as “stop signs,” are a means by which malignant cells evade the immune system and eventually grow into cancer. These prevent them from being attacked and killed by the immune system. Checkpoint inhibitors are a kind of medication that can remove the stop signals and restore the immune system’s functionality. Even while these medications don’t work for everyone, when they do, the effects may be profound, long-lasting, and in some cases, even curative for patients with extremely advanced cancer. Determining why immunotherapy is effective for some individuals but not for others is a high goal for our research.