Hepatitis C can lead to primary liver cancer in a small percentage of people. Primary liver cancer is cancer that starts in the cells of the liver rather than spreading there from somewhere else. There are two main types of primary liver cancer; hepatocellular carcinoma (HCC) which develops in the cells of the liver and bile duct cancer (Cholangiocarcinoma) which develops in the cells lining the bile ducts. People infected with HCV are much more likely to develop HCC than bile duct cancer.
The overall risk of developing HCC for people infected with hepatitis C is relatively small. It usually develops decades after infection and is almost exclusively confined to people who have already progressed to cirrhosis. However, once liver cancer does develop, in the absence of a liver transplant, the survival rates are low.
Likely outcomes of HCC
The outcome of HCC depends on how far it has progressed at the time of diagnosis and also on the general condition of the liver, so every case of HCC is unique. In broad terms it is expected that 90% of people with a small single tumour will survive for one year, 50% for three years, and 20% for five years. In patients with more advanced disease, it is expected that 30% will survive for one year, 8% for three years, and none for five years. Primary liver cell cancer can be a very aggressive tumour that leads to death with a few months, but conversely in a small proportion of people the tumour develops very slowly and they can survive without therapy for many years
Treatment for HCC can either be curative (i.e. it can cure the cancer) or palliative (i.e. it can stop tumours growing bigger or shrink them).The only realistic curative treatment options are either surgery to remove the cancer or a liver transplant. Surgery or a transplant is only possible if the cancer has not already spread beyond the liver. Palliative options include chemoembolisation and radio frequency ablation.
Factors that potentially increase the risk of developing HCC
- Age is a possible factor, although it is not clear at present whether this is because of age itself or because of the duration of infection or a combination of the two. One study has shown that elderly males with advanced cirrhosis have a 25% risk of developing HCC within five years. This is much higher than the average.
- High serum bilirubin levels
- A more advanced stage of cirrhosis
- Alcohol
- Co-infection with HBV. Being a carrier of hepatitis B virus dramatically increases the risk of developing HCC by 200 per cent.
- Being male. This link, though, is still controversial.
Diagnosis of HCC
Diagnosing a tumour at an early stage significantly increases the chances of recovery, which is why regular screening for HCC (usually every six months) for those with cirrhosis is very important. Tumours over 4cm are usually incurable.
Identifying tumours in a cirrhotic, nodular liver is often difficult. A tumour needs to be distinguished on a scan from the regenerative nodules, and this is not easy (regenerative nodules are clusters of liver cells that have been cut off from the rest of the liver by scarring but still replicate and form nodules). Accurate diagnosis can often only be achieved using a variety of tests, although even when this is done it is not always a guarantee that tumours will be properly identified.
