Complications
HCC causes obstructive jaundice by invasion of the biliary tree, compression of the intrahepatic duct, or rarely, as a result of hemobilia.
Potentially life-threatening. Any patient with profound weakness or signs of organ failure may require hospitalization to halt the loss of weight and restore organ function. The patient should be monitored carefully for re-feeding syndrome in this situation.
Rarely, HCC-related hypoglycemia may occur because of production of insulin-like growth factor-2 (IGF-2). In advanced HCC, it may occur due to the high metabolic needs of HCC.
Due to chronic liver disease and cirrhosis. Manifestations include variceal bleeding (common cause of death), hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome.
Chronic watery diarrhea is an uncommon complication of HCC.
It is likely due to the immunoreactivity of vasoactive intestinal polypeptide or gastrin.
Aggressive fluid and electrolyte management is required.
Due to osteolytic metastases or secretion of parathyroid hormone-related proteins.
This is a life-threatening complication that is associated with sudden onset of severe abdominal pain with distension, an acute drop in hematocrit, and hypotension.
It is diagnosed by peritoneal lavage and laparotomy.
Computed tomography scan of abdomen shows liver mass and free intraperitoneal blood.
Advanced Child-Pugh class, advanced Okuda stage, and peripheral location are risk factors for spontaneous rupture of HCC.[145][146]
Urgent angiography, embolization of the bleeding vessel, or even surgery is required to control bleeding. Although the risk of peritoneal dissemination is high, delayed resection may be considered, if feasible.
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