الفهرس 
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Abstract
Hepatocellular carcinoma represents 85% - 90% of primary liver tumors ; it represents the second leading cause of cancer related death all over the world. There is a growing incidence of HCC worldwide and similarly, the frequency of HCC has been almost doubled over the last decade in Egypt. Patients and Methods : This was a retrospective study included 497 HCC patients data collected from Clinical Oncology and Nuclear Medicine Department, Mansoura University Hospital from 1999 to 2019 , HCC patients were classified into 1st decade (from 1999 to 2009) and 2nd decade (2009-2019) Diagnosis of HCC was based on clinical, laboratory, (AFP) and radiological examinations (US and triphasic CT scan). Results : The study revealed that, the average age of HCC cases was 57 years, the majority of these were males (88%), resident in rural areas (70%), about one fourth of them were smokers (26.4%), DM was present in 14% of these while only 7% were hypertension. Thirty presents (30%) of them represented by ascites and (20%) by hepatic encephalopathy of different grades. The majority of HCC patients (92.2%) has HCV Abs positive. HBS Ag were positive in 2.4% while mixed infection (HCV Abs +ve and HBS Ag +ve) in 2% of patients only. The median level of AFP was 300 ng/ml. The severity of underlying chronic liver disease was assessed by Child-Pugh score the mean score was 7.5 (from 6-11) and MELD score (the mean score was 18.8 (from 6-29). Regarding tumor characters, HCC mass was located in the Right lobe of the liver in (63.8%), in the left lobe in (26.6%) and both lobes were affected in (9.6%). Single focal hepatic lesion was detected in about 60% of patients, 3 focal lesions in about (20%), 2 focal lesions or multifocal HCC in the remaining percent. The median size of the largest tumor’s diameter was 5 cm by US and 5.3 cm by triphasic CT, PVT, vascular invasion, LN and distant metastasis were detected in (35.6%), (40%), (40%) and (54%) of patients respectively. In less than one third of HCC cases, the tumors were within Milan criteria (30%). Conclusion the 1st decade showed significant higher frequency of patients presented with marked enlarged spleen and splenectomy. While the second decade showed significantly higher frequency of patient’s resident in rural areas. Significantly higher frequency of DM, advanced hepatic encephalopathy grade III/ IV and unfortunately more aggressive tumor with PVT, vascular invasion, LN metastasis and distant metastasis.