Hepatocellular carcinoma and nutrition

Chapter 4.7
Hepatocellular carcinoma and nutrition

Frances Dorman

King’s College Hospital NHS Foundation Trust, London, UK

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. It has a poor 5-year survival rate of less than 5%. The incidence of HCC has been increasing worldwide, especially in Japan [1]. There is a higher incidence in developing countries compared to developed countries. Patients with liver cirrhosis are primarily affected and HCC is the most common cause of death [2]. There is a higher incidence in males and in older patients.

Liver cirrhosis is a risk regardless of aetiology. However, HCC can also occur in non-cirrhotic patients. In cirrhotic patients the presence of viral hepatitis, increased alcohol intake and hereditary Haemochromatosis also increases the risk of developing HCC. In Hepatitis B the DNA virus mutation rate is 10 times higher than that of other DNA viruses. The virus binds itself to the liver cells’ DNA, which disrupts normal cell activity and growth, leading to cell destruction and mutation [3].

Hepatocellular carcinoma often has no or only mild or vague symptoms. It is important to detect HCC early at a stage when potentially effective treatment can be offered. Treatments include surgical resection, liver transplant and percutaneous destruction.

4.7.1 Treatments

Surgery achieves a high rate of complete response and is the treatment of choice in non-cirrhotic patients. A right-sided hepatectomy in cirrhotic patients can increase the risk of inducing decompensation more than a left-sided hepatectomy [4]. Liver resection includes wedge resection and segmentectomy. If HCC is detected early, the survival rate is >90% after a successful resection. Liver transplantation is considered to be the first-line treatment for single tumours less than 5 cm or ≤3 nodules ≤ 3 cm (Milan Criteria) not suitable for resection [5]. Five-year survival of patients transplanted for HCC is above 60%, but recurrence rates are estimated at 30-40%.

Surgical techniques have reduced the operative morbidity and mortality associated with the resection of HCC. Patients with cirrhosis who received perioperative nutrition had better outcomes after surgery and weight loss was less severe than in those who did not [6].

After surgery, patients often have reduced oral intake due to reduced appetite, pain and nausea. Patients have increased nutritional requirements after surgery, often necessitating the use of oral nutritional supplements, enteral or parenteral nutrition. These methods of nutritional support should be considered if patients are unable to meet their nutritional requirements via diet alone. The influence of nutritional status on postoperative morbidity and mortality has been well documented [7].

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