Painful or growing hepatomegaly, a hepatic friction rub, or a bruit suggests the diagnosis, especially in patients with known cirrhosis or in those from areas where HBV is endemic. Except for the presence of -fetoprotein in serum, biochemical tests are of little diagnostic help. Scanning is less valuable in patients with underlying cirrhosis because results are more difficult to interpret. Hepatic arteriography often gives characteristic findings of tumor and should be considered to confirm a strongly suspected diagnosis and to outline the vascular anatomy when surgery is planned. The prognosis for hepatocellular carcinoma is usually grim, and treatment is generally unsatisfactory.
Surgical resection provides the best hope but is suitable in only a few cases.
Patients with small localized tumors may have prolonged survival after resection, but the diagnosis is usually established late, and death often occurs within a few months. The tumor is not radiosensitive, and chemotherapy is usually unsuccessful, even when hepatic artery infusion or chemoembolization is used. It remains to be proven whether routine screening of high-risk individuals can lower mortality from the disease. Moderately good long-term survival rates have been reported after liver transplantation, but this may largely reflect selection bias for patients with relatively small localized tumors. Most experts remain wary of transplantation for malignancy.