TN 54 (09-22)

DI 23022.225 Hepatocellular Carcinoma




Adult HCC; Adult Hepatocellular Carcinoma; HCC; Hepatocellular Cancer; Hepatoma; Liver Cancer


The most common type of liver cancer is Hepatocellular Carcinoma (HCC). HCC is a type of adenocarcinoma that forms in the main liver cells called hepatocytes. It is more likely to develop in men than in women and becomes more common as individuals get older. Most individuals diagnosed with HCC are over the age of 60. HCC is responsible for over 12,000 deaths per year in the United States, making it one of the most serious cancers in adults.

Having cirrhosis (scarring of the liver due to previous damage) increases the risk of getting HCC. The risk varies depending on the cause of the cirrhosis. Cirrhosis can be caused by:

  • Chronic viral infection such as hepatitis B or hepatitis C;

  • Long-term alcohol drinking;

  • Inherited diseases such as iron overload disorder (hemochromatosis) and alpha 1 antitrypsin deficiency;

  • Non-alcoholic fatty liver disease; and

  • Primary biliary cholangitis (PBC).


Diagnostic testing: Diagnosis of HCC includes a clinical examination, which includes a medical history and a thorough physical examination. Many blood tests may be used to check for liver problems. For example, one blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of HCC.

Several other tests may be performed to diagnose HCC including:

  • Computerized tomography (CT) scan;

  • Ultrasound tests;

  • Magnetic resonance imaging (MRI);

  • Angiogram; and

  • Biopsy.

Physical findings: HCC is sometimes called a “silent disease” because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include:

  • Pain in the upper abdomen on the right side;

  • Pain that may extend to the back and shoulder;

  • Swollen abdomen (bloating);

  • Weight loss;

  • Loss of appetite and feelings of fullness;

  • Weakness or feeling very tired;

  • Nausea and vomiting;

  • Yellow skin and eyes, and dark urine from jaundice; and

  • Fever.

ICD-9: 155.0, 155.1, 230.8

ICD-10: C22.0


HCC is rarely discovered early and often does not respond to current treatments-thus, the prognosis is often poor. For patients with advanced disease, care is focused on keeping the patient as comfortable as possible. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.


HCC can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have surgery. However, treatments other than surgery may be able to control the disease and help patients live longer and feel better. The choice of treatment depends on the condition of the liver; the number, size, and location of tumors; and whether the cancer has spread outside the liver. Options include surgery, radiation therapy, chemotherapy, percutaneous ethanol injections, and hepatic arterial infusions. For a few patients, liver transplantation may be an option.


Suggested MER for Evaluation:

  • A pathology report stating that liver cancer is present in a biopsy specimen; or

  • An MRI or CT scan showing liver abnormalities compatible with HCC along with elevated AFP meeting the requirements under the diagnostic testing above.

Suggested Listings for Evaluation:






Prognosis is poor based on confirmed diagnosis alone.




* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


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DI 23022.225 - Hepatocellular Carcinoma - 09/06/2022
Batch run: 08/11/2023