Where does hepatocellular carcinoma (HCC) metastasize to?

From the Guidelines

Hepatocellular carcinoma (HCC) most commonly metastasizes to the lung, adrenal glands, peritoneum, and bone. According to the most recent guidelines, the major risk factors for the development of HCC are cirrhosis and chronic liver disease, regardless of etiology, and common sites of HCC metastasis include the lung, adrenal glands, peritoneum, and bone 1. The metastatic pattern of HCC is influenced by its vascular invasion tendency and the liver's unique dual blood supply from the hepatic artery and portal vein.

Metastatic Sites

• The lung is a common site of metastasis due to venous drainage from the liver flowing directly to the lungs through the inferior vena cava.
• The adrenal glands are also frequently affected, highlighting the importance of thorough imaging and staging.
• The peritoneum and bone are other less frequent sites of metastasis, with bone metastases typically affecting the vertebrae, ribs, and pelvis, causing significant pain and potential pathological fractures.
• Understanding these metastatic patterns is crucial for proper staging, treatment planning, and surveillance of HCC patients, as early detection of metastatic disease significantly impacts treatment options and prognosis, as noted in the guidelines 1.

Clinical Implications

The majority of patients diagnosed with HCC have advanced disease, and only a small percentage are eligible for potentially curative therapies 1. It is essential that all patients be evaluated by a multidisciplinary team prior to initiation of treatment, and careful patient selection for treatment and patient engagement are essential. The use of AFP and liver US as screening methods for HCC can aid in early detection and potentially improve outcomes 1.

From the Research

Metastasis of Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) commonly metastasizes to various sites, including:

• Lungs 2, 3, 4, 5
• Lymph nodes 2, 3, 4, 5
• Adrenal glands 2, 3
• Bones 2, 3, 4, 6, 5
• Skull 3
• Portal vein 4
• Portal lymph nodes 4
• Intra-abdominal lymph nodes 4
• Kidneys 6, 5
• Nasopharynx 2
• Orbit 4, 6
• Maxillary sinus 6
• Retrobulbar region 6
• Soft tissue 5
• Rib 5
• Ovaries, as a rare site of extrahepatic metastasis 2
• Brain, as a rare site of extrahepatic metastasis 2
• Cardiac musculature, as a rare site of extrahepatic metastasis 2
• Skeletal musculature, as a rare site of extrahepatic metastasis 2

Rare Sites of Metastasis

Some rare sites of metastasis have been reported, including:

• Nasopharynx 2
• Orbit 4, 6
• Maxillary sinus 6
• Retrobulbar region 6
• Soft tissue 5
• Rib 5