Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, meaning cancer that starts in the liver rather than spreading there. Most cases develop in people with cirrhosis or long-term liver disease, such as chronic hepatitis B or C, alcohol-related liver disease or fatty liver disease. Hepatitis B can lead to HCC even without cirrhosis. Long-term exposure to aflatoxin, a toxin from mold on stored grains and nuts, adds to the risk, especially together with hepatitis B. Early HCC often causes no symptoms, which is why people at high risk are offered regular surveillance.

Lab tests linked to hepatocellular carcinoma:

• Aflatoxin group (B1, B2, G1, G2): measures exposure to aflatoxins. It reflects a risk factor, not the presence of cancer.
• Doctors also order alpha-fetoprotein (AFP), liver function tests and tests for hepatitis B and C. HCC is diagnosed mainly with multiphase CT or MRI, and sometimes a biopsy.

How results are read:

• A raised AFP can support the diagnosis, but many people with HCC have a normal AFP. It can also rise in hepatitis flares, pregnancy and some other cancers.
• People with cirrhosis or high-risk hepatitis B are usually offered an ultrasound about every 6 months, often with AFP.
• A positive aflatoxin test shows exposure. It does not diagnose liver cancer or predict it in an individual.

When to see a doctor:

• See a doctor about unexplained weight loss, pain or a lump under the right ribs, or a swollen abdomen, especially if you have liver disease.
• Get emergency care for vomiting blood, black tarry stools, new confusion, or sudden severe abdominal pain.
• If you have cirrhosis or chronic hepatitis B, ask whether you should be on a surveillance program.

Clinical takeaway: liver cancer is diagnosed with imaging, AFP gives supporting but limited information, and aflatoxin testing shows exposure rather than disease.