Signs and Symptoms of Hepatocellular Carcinoma
Localized HCC is asymptomatic for much of its natural history, and the majority of patients are diagnosed at advanced stages when nonspecific symptoms finally appear. 1
Early Stage Disease
- Most patients with early HCC have no symptoms, which is why surveillance programs are critical for at-risk populations 1
- Early detection typically occurs through screening rather than symptom presentation 2
- Patients may remain completely asymptomatic until disease progression 1
Advanced Disease Symptoms
When symptoms do appear, they are typically nonspecific and indicate more advanced disease:
Constitutional Symptoms
- Weight loss - significantly more prevalent in HCC patients compared to cirrhosis alone 1, 3
- Anorexia - common presenting symptom in advanced disease 1, 3
- Malaise and fatigue - frequently reported 1, 4
- Fever - may occur, though tumor-related fever is rare; night sweats are common in advanced disease 1, 5
Abdominal Symptoms
- Upper abdominal pain or right upper quadrant discomfort - significantly associated with HCC presence 1, 3
- The combination of abdominal pain, weight loss, or anorexia has 73% sensitivity and 79% specificity for HCC in cirrhotic patients 3
Signs of Liver Disease Progression
- Jaundice - indicates advanced disease or biliary involvement 1
- Hepatomegaly - palpable liver enlargement on physical examination 1, 6
- Ascites - new or worsening fluid accumulation 1
- Encephalopathy - altered mental status from hepatic dysfunction 1
- Splenomegaly - associated with portal hypertension 1
Rare Presentations
- Extrahepatic metastatic symptoms - rarely, patients present with symptoms exclusively from metastases (bone pain from pathological fractures, respiratory symptoms from lung metastases) before liver disease is recognized 5
- Hepatic rupture - spontaneous rupture can occur, particularly in pregnancy, presenting with acute abdominal pain and hemodynamic instability 1
Clinical Context
A critical pitfall is that symptom presence indicates advanced disease in most cases - by the time patients develop abdominal pain, weight loss, or jaundice, curative treatment options are often limited 1, 2. This underscores why surveillance with ultrasound every 6 months is recommended for at-risk populations rather than waiting for symptoms to develop 1.
The sensitivity of clinical symptoms alone (73%) is insufficient for screening, and their appearance typically signals that the window for potentially curative therapies has narrowed 3. In cirrhotic patients presenting with new symptoms of weight loss, abdominal pain, or anorexia, immediate imaging evaluation is warranted 3.