Diagnosis
As many of the cases present with atypical features and the majority are asymptomatic, the main modality for proper diagnosis is imaging studies with a wide variety of methods available including:
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- Ultrasound: Avery useful first imaging study used for screening mainly which helps indicate the presence of a mass or not, and it is also very helpful in determining the amount of fluid within the abdomen in people suffering from ascites, but it isn’t reliable enough on its own for diagnosis, as it cannot accurately estimate the extent of spread or differentiate between the different types of masses within the liver.
- Triphasic abdominal CT scan: These scans are more reliable than ultrasound in revealing the size, location, extent, vascularity, portal vein invasion, and lymph node metastasis and differentiates between the different types of masses within the liver showing rapid arterial enhancement and rapid venous washout in hepatocellular carcinoma.
- CT angiography: Another type of CT scans that shows the vascularity of the tumor and portal vein invasion or thrombosis more accurately and is mostly used in treatment planning.
- Dynamic MRI scans: They are the most sensitive and specific for HCC identification, especially smaller onesappearing as hyperechoic mass in T2 weighted images and hypoechoic mass inT1 weighted images.
To confirm the diagnosis:
The American association for the study of liver diseases recommends screening people with chronic liver cirrhosis with an ultrasound every 6 months and measurement of the tumor marker AFP to help identify the disease in its early curable stages as well as to decrease the rates of morbidity and mortality associated with HCC.
Spread :
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- Lymphatic spread to other parts of the liver:to porta hepatis or to other abdominal lymph nodes.
- Blood spread to the lung, bone,or adrenals.
- Direct infiltration of the diaphragm and surrounding structures.
