Clinical Features Symptoms in HCC patients include abdominal pain, weight loss, weakness, abdominal fullness and swelling, jaundice, and nausea (Table 88-3). Presenting signs and symptoms differ somewhat between high- and low-incidence areas. The most common symptom is abdominal pain in high-risk areas, especially in South African blacks; by contrast, only 40–50% of Chinese and Japanese patients present with abdominal pain. Abdominal swelling may occur as a consequence of ascites due to the underlying chronic liver disease or may be due to a rapidly expanding tumor. Occasionally, central necrosis or acute hemorrhage into the peritoneal cavity leads to death. In. | Chapter 088. Hepatocellular Carcinoma Part 3 Clinical Features Symptoms in HCC patients include abdominal pain weight loss weakness abdominal fullness and swelling jaundice and nausea Table 88-3 . Presenting signs and symptoms differ somewhat between high- and low-incidence areas. The most common symptom is abdominal pain in high-risk areas especially in South African blacks by contrast only 40-50 of Chinese and Japanese patients present with abdominal pain. Abdominal swelling may occur as a consequence of ascites due to the underlying chronic liver disease or may be due to a rapidly expanding tumor. Occasionally central necrosis or acute hemorrhage into the peritoneal cavity leads to death. In countries with an active surveillance program HCC tends to be identified at an earlier stage when symptoms may be due only to the underlying disease. Jaundice is usually due to obstruction of the intrahepatic ducts by the underlying liver disease. Hematemesis may occur due to esophageal varices from the underlying portal hypertension. Bone pain is seen in 3-12 of patients but necropsies show bone metastases in 20 of patients. Patients may be asymptomatic. Table 88-3 Hepatocellular Carcinoma Clinical Presentation at the University of Pittsburgh Liver Cancer Center N 547 Number Patients of Symptom No symptom 129 24 Abdominal pain 219 40 Other workup of anemia and various diseases 64 12 Routine physical exam finding elevated LFTs 129 24 Weight loss 112 20 Appetite loss 59 11 Weakness malaise 83 15 Jaundice 30 5 Routine CT scan screening of known cirrhosis 92 17 Cirrhosis symptoms ankle swelling abdominal bloating increased girth pruritus GI bleed 98 18 Diarrhea 7 1 Tumor rupture 1 Patient .
