Symptoms are often a late feature of the disease and can be divided into those arising from the mechanical effects of tumour growth, para-neoplastic symptoms, and deterioration of liver function. Right upper-quadrant abdominal pain is the most common symptom of HCC. Symptoms associated with advanced disease include:

♦ Abdominal distension

♦ Intra-peritoneal haemorrhage

In cirrhotic patients, HCC may present as a rapid deterioration in hepatic function. Jaundice is uncommon unless liver function is severely impaired or the tumour has impinged upon a major intra-hepatic bile duct. Clinical examination may reveal stigmata ofchronic liver disease, and hepatomegaly is usual; 30-60% have ascites. Para-neoplastic effects include:

♦ Hypoglycaemia

♦ Erythrocytosis

♦ Hypercalcaemia

♦ Hypercholesterolaemia

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