Hepatocellular carcinoma classification: Difference between revisions

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==Overview==
==Overview==


Hepatocellular carcinoma may be classified according to the histological subtypes. The staging of HCC is based on the TNM staging system.
Hepatocellular carcinoma (HCC) may be classified into different [[histological]] subtypes based on the [[microscopic]] features. The [[TNM Staging System|TNM]] staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adapted from the original Okuda classification system that takes [[cirrhosis]] into account.


==Classification ==
==Classification ==


*Hepatocellular carcinoma may be classified according to the histological subtypes:<ref name="pmid268389792">{{cite journal |vauthors=Shafizadeh N, Kakar S |title=Hepatocellular Carcinoma: Histologic Subtypes |journal=Surg Pathol Clin |volume=6 |issue=2 |pages=367–84 |year=2013 |pmid=26838979 |doi=10.1016/j.path.2013.03.007 |url=}}</ref><ref name="pmid16178893">{{cite journal |vauthors=Matsuura S, Aishima S, Taguchi K, Asayama Y, Terashi T, Honda H, Tsuneyoshi M |title='Scirrhous' type hepatocellular carcinomas: a special reference to expression of cytokeratin 7 and hepatocyte paraffin 1 |journal=Histopathology |volume=47 |issue=4 |pages=382–90 |year=2005 |pmid=16178893 |doi=10.1111/j.1365-2559.2005.02230.x |url=}}</ref>  
=== Classification based on histological features ===
*Hepatocellular carcinoma may be classified into different [[histological]] subtypes based on the [[microscopic]] features:<ref name="pmid268389792">{{cite journal |vauthors=Shafizadeh N, Kakar S |title=Hepatocellular Carcinoma: Histologic Subtypes |journal=Surg Pathol Clin |volume=6 |issue=2 |pages=367–84 |year=2013 |pmid=26838979 |doi=10.1016/j.path.2013.03.007 |url=}}</ref><ref name="pmid16178893">{{cite journal |vauthors=Matsuura S, Aishima S, Taguchi K, Asayama Y, Terashi T, Honda H, Tsuneyoshi M |title='Scirrhous' type hepatocellular carcinomas: a special reference to expression of cytokeratin 7 and hepatocyte paraffin 1 |journal=Histopathology |volume=47 |issue=4 |pages=382–90 |year=2005 |pmid=16178893 |doi=10.1111/j.1365-2559.2005.02230.x |url=}}</ref><ref name="DrebberDienes2006">{{cite journal|last1=Drebber|first1=U.|last2=Dienes|first2=H. P.|title=Diagnose und Differenzialdiagnose des hepatozellulären Karzinoms|journal=Der Pathologe|volume=27|issue=4|year=2006|pages=294–299|issn=0172-8113|doi=10.1007/s00292-006-0842-1}}</ref>  
**[[Fibrolamellar hepatocellular carcinoma|Fibrolamellar carcinoma]]   
**[[Fibrolamellar hepatocellular carcinoma|Fibrolamellar carcinoma]]   
**Sarcomatoid HCC  
**Sarcomatoid HCC  
**[[Undifferentiated]] carcinoma
**[[Undifferentiated]] carcinoma
**Combined HCC- <br>[[cholangiocarcinoma]] (HCC-CC)
**Combined HCC-[[cholangiocarcinoma]] (HCC-CC)
**[[Lymphoepithelioma]]
**[[Lymphoepithelioma]]
**Scirrhous hepatocellular carcinoma (scirrhous HCC)
**Scirrhous hepatocellular carcinoma (scirrhous HCC)
**[[Trabecula|Trabecular]] hepatocellular carcinoma
**Pseudoglandular hepatocellular carcinoma
**[[Acinar]] hepatocellular carcinoma
**Compact hepatocellular carcinoma
{{familytree/start}}
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{{familytree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Hepatocellular carcinoma}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Hepatocellular carcinoma}}
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</small>
</small>


==Staging==
===Classification based on TNM staging===
According to the [[TNM staging system]], there are four stages of hepatocellular carcinoma based on the [[tumor]] size, [[lymph node]] involvement, and distant [[metastasis]]. Although the [[TNM staging system]] is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is preferable because it is adopted from the original Okuda classification system that takes [[cirrhosis]] into account.
====TNM staging system====


===TNM staging system===
According to the [[TNM staging system]], there are four stages of hepatocellular carcinoma based on the [[tumor]] size, [[lymph node]] involvement, and distant [[metastasis]].<ref name="cancerca">Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab</ref>
 
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.<ref name="cancerca">Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab</ref>


===Primary tumor===
===Primary tumor===
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
|'''Primary tumor'''
|'''Interpretation'''
|-
||TX
||TX
||Primary tumour cannot be assessed
||Primary [[tumor]] cannot be assessed
|-
|-
| T0||No evidence of primary tumour
| T0||No evidence of [[primary tumor]]
|-
|-
| T1||A single tumour with no invasion into the blood vessels of the liver
| T1||A single [[tumor]] with no invasion into the [[blood vessels]] of the [[liver]]
|-
|-
| T2||A single tumour with invasion into the blood vessels or multiple tumours, none more than 5 cm in size
| T2||A single [[tumor]] with invasion into the [[blood vessels]] or multiple [[tumors]], none more than 5 cm in size
|-
|-
| T3a||Multiple tumours, with any tumour larger than 5 cm
| T3a||Multiple [[tumors]], with any tumor larger than 5 cm
|-
|-
| T3b||The tumour has grown into either the portal or hepatic vein
| T3b||The [[tumor]] has grown into either the [[Portal vein|portal]] or [[hepatic vein]]
|-
|-
| T4||The tumour has grown into nearby organs (other than the gallbladder) or the tumour has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum)
| T4||The [[tumor]] has grown into nearby organs (other than the [[gallbladder]]) or the [[tumor]] has grown into the layer of [[Tissue (biology)|tissue]] that covers the [[Organ (anatomy)|organs]] in the [[abdomen]] ([[visceral peritoneum]])
|}
|}


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{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| NX||Regional lymph nodes cannot be assessed
|'''Lymph node involvement'''
|'''Interpretation'''
|-
| NX||Regional [[lymph nodes]] cannot be assessed
|-
|-
| NX||No regional lymph node metastasis
| N0||No regional [[lymph node]] [[metastasis]]
|-
|-
| NX||Regional lymph node metastasis
| N1||Regional [[lymph node]] [[metastasis]]
|}
|}


===Distance metastasis===
===Distant metastasis===


{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| M0
| M0
|No distant metastasis
|No distant [[metastasis]]
|-
|-
| M1||Distant metastasis
| M1||Distant [[metastasis]]
|}
|}


===Clip and Okuda Staging Systems for Hepatocellular Carcinoma===
===Clip and Okuda staging systems for hepatocellular carcinoma===
Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.
Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that takes [[cirrhosis]] into account.


'''CLIP Classification'''
'''CLIP Classification'''
{| class="wikitable"
{| class="wikitable"
!
! style="background:#4479BA; color: #FFFFFF;" align="center" |Variable
! colspan="3" | colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Points
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Points
|-
|-
|'''Variable'''
|
|0
|0
|1
|1
|2
|2
|-
|-
|[[Tumor|i.Tumor]] number (%)
|'''i.'''Tumor number (%)
|Single
|Single
|Multiple
|Multiple
|–
|–
|-
|-
|Hepatic replacement by tumor
|[[Hepatic]] replacement by [[tumor]]
|<50
|<50
|<50
|<50
|>50
|>50
|-
|-
|ii. [[Child-Pugh score]]
|'''ii.''' [[Child-Pugh score]]
|A
|A
|B
|B
|C
|C
|-
|-
|iii. α Fetoprotein level (ng/mL)
|'''iii.''' [[Alpha-fetoprotein|α fetoprotein level]] (ng/mL)
|<400  
|<400  
|≥400
|≥400
|–
|–
|-
|-
|iv.[[Portal vein thrombosis]] (CT)   
|'''iv'''.[[Portal vein thrombosis]] (CT)   
|No
|No
|Yes
|Yes
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| colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |'''OKUDA Classification'''  
| colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |'''OKUDA Classification'''  
|-
|-
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Tumor Extent*'''   
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Tumor extent<sup>a</sup>'''   
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Bilirubin (mg/dL)'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Bilirubin (mg/dL)'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Albumin (g/L)'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Albumin (g/L)'''
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|(+)  
|(+)  
|(−)
|(−)
|-
| colspan="8" |Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+)
|}
|}
a. Liver span occupied by the [[tumor]].
<small>
'''Adopted from Harrison's Textbook of Medicine*'''
</small>


==References==
==References==
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[[Category:Types of cancer]]
[[Category:Up-To-Date]]
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[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Emergency medicine]]

Latest revision as of 22:07, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Hepatocellular carcinoma (HCC) may be classified into different histological subtypes based on the microscopic features. The TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adapted from the original Okuda classification system that takes cirrhosis into account.

Classification

Classification based on histological features

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatocellular carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fibrolamellar carcinoma
 
Undifferentiated carcinoma
 
 
Sarcomatoid HCC
 
Combined HCC-CC*
 
 
Lymphoepithelioma
 
Scirrhous HCC
 
 
 

Abbreviations: Combined HCC-cholangiocarcinoma (HCC-CC)*

Classification based on TNM staging

According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis. Although the TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is preferable because it is adopted from the original Okuda classification system that takes cirrhosis into account.

TNM staging system

According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.[4]

Primary tumor

Primary tumor Interpretation
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 A single tumor with no invasion into the blood vessels of the liver
T2 A single tumor with invasion into the blood vessels or multiple tumors, none more than 5 cm in size
T3a Multiple tumors, with any tumor larger than 5 cm
T3b The tumor has grown into either the portal or hepatic vein
T4 The tumor has grown into nearby organs (other than the gallbladder) or the tumor has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum)

Regional lymph node

Lymph node involvement Interpretation
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis

Distant metastasis

M0 No distant metastasis
M1 Distant metastasis

Clip and Okuda staging systems for hepatocellular carcinoma

Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that takes cirrhosis into account.

CLIP Classification

Variable Points
0 1 2
i.Tumor number (%) Single Multiple –
Hepatic replacement by tumor <50 <50 >50
ii. Child-Pugh score A B C
iii. α fetoprotein level (ng/mL) <400 ≥400 –
iv.Portal vein thrombosis (CT) No Yes –
CLIP stages (score = sum of points): CLIP 0, 0 points; CLIP 1, 1 point; CLIP 2, 2 points; CLIP 3, more than 3

points.

OKUDA Classification

OKUDA Classification
Tumor extenta Bilirubin (mg/dL) Albumin (g/L) Ascites
≥50% <50 ≥ 3 <3 ≤3 >3 + –
(+) (−) (+) (−) (+) (−) (+) (−)
Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+)

a. Liver span occupied by the tumor.

Adopted from Harrison's Textbook of Medicine*

References

  1. ↑ Shafizadeh N, Kakar S (2013). "Hepatocellular Carcinoma: Histologic Subtypes". Surg Pathol Clin. 6 (2): 367–84. doi:10.1016/j.path.2013.03.007. PMID 26838979.
  2. ↑ Matsuura S, Aishima S, Taguchi K, Asayama Y, Terashi T, Honda H, Tsuneyoshi M (2005). "'Scirrhous' type hepatocellular carcinomas: a special reference to expression of cytokeratin 7 and hepatocyte paraffin 1". Histopathology. 47 (4): 382–90. doi:10.1111/j.1365-2559.2005.02230.x. PMID 16178893.
  3. ↑ Drebber, U.; Dienes, H. P. (2006). "Diagnose und Differenzialdiagnose des hepatozellulären Karzinoms". Der Pathologe. 27 (4): 294–299. doi:10.1007/s00292-006-0842-1. ISSN 0172-8113.
  4. ↑ Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab

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