Hepatocellular carcinoma presenting with obstructive jaundice

Background: Jaundice occurs in 5-44% of patients with hepatocellular carcinoma (HCC). It is an important clinical presentation as the different aetiological causes of jaundice in HCC determine the therapeutic approach and the prognosis. This article aims to review the classification, management and prognosis of patients with jaundice associated with HCC. Methods: A Medline search was undertaken to identify articles using the key words 'hepatocellular carcinoma', 'jaundice' and 'tumour thrombus'. Additional articles were identified by a manual search of the references from the key articles. Results: Patients with jaundice due to hepatic parenchymal insufficiency (hepatocellular type) have a very dismal prognosis. For patients with biliary obstruction due to HCC (icteric type), the reported 1-, 3- and 5-year survival rates after curative resection were 57.1-100%, 20-47% and 6.7-45%, respectively. The mean survival after palliative biliary drainage alone was less than 6 months but when biliary drainage was combined with other palliative treatment, the mean survival could be up to 1 year. Conclusions: It is important to differentiate the hepatocellular type from the icteric type of HCC. For patients with the icteric type of HCC, curative liver resection can achieve a survival comparable to that in patients without jaundice. For patients with unresectable icteric type of HCC, treatment can provide improvement in patient's quality of life and survival.