ICD-10-code hepatocellular carcinoma
C22.0 carcinoma hepatocellular

The hepatocellular carcinoma (scientifically correct: hepatocellular carcinoma or carcinoma hepatocellular) is a malignant cancer that comes directly from the liver cells. Most goes ahead to a chronic injury to the liver cells. It is abbreviated with HCC. It should not be confused with liver metastases.

Epidemiology

The hepatocellular carcinoma is one of the most common malignant tumors. Approximately 6% of all cancers in men and around 3% in women are hepatocellular carcinomas.

This show, however, marked geographical differences. In all countries where hepatitis B often occurs, hepatocellular carcinoma is also often found. This is particularly true for Asia and Africa. In Europe, however, it is rather rare and usually develops at the bottom of liver cirrhosis.

Etiology and Risk Factors

Risk factors for HCC are:

* Chronic viral hepatitis
* Alcoholic cirrhosis
* Hemochromatosis (in combination with cirrhosis, the risk of having a hepatocellular carcinoma to develop in order to increase the 219fache)
* Alpha1-Antitrypsin
* Mycotoxins such as aflatoxin B1 (Aspergillus flavus)

Pathology

Macroscopically liver cell carcinomas appear as knotty or infiltrate tumors. The knotty can type one by one (solitary) or ausgesäht in many small tumors nests (multiple). The tumor node are rounded to oval, gray, or – if the cancer produces bile – even greenish in color. The diffuse type is less defined and often penetrates the blood vessels or bile ducts.

In the microscopic picture are four zytoarchitektonische and cytological pattern of hepatocellular carcinoma distinguishable: fibrolamellärer, pseudoglandulärer (adenoider) Pleomorphic (giant cells) and klarzelliger type. In the same highly carcinoma tumor cells largely healthy hepatocytes and forms an almost normal Zytoarchitektur with Trabekeln. They often contain bile droplets in the cytoplasm. More entdifferenzierte forms have cells with large shape differences (Pleomorphie) and giant cells. In the interior of the tumor mass can lead to necrosis, because the blood supply is inadequate there.

Diagnosis and Therapy

For the diagnosis of HCC there are ultrasonography (with or without contrast), the computed and because of its strong Hypervaskularisation angiography is also suitable.

The alpha-fetoprotein (alpha-1-fetoprotein) is a useful tumor marker for HCC. When healthy, the concentration of alpha-1-fetoprotein 0.1 to 5.8 ng / ml. Approximately 50 to 90% of HCC patients is the alpha-1-fetoprotein levels in blood increased.

Since most HCC is often discovered late, and often the underlying cirrhosis, the therapeutic options is limited, the treatment of this disease remains difficult and the prognosis is unfavorable.