Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world with rising incidence. Globally, there has been substantial variation in prevalence of risk factors for HCC over years, like control of viral hepatitis in developing countries but growing epidemic of fatty liver disease in developed world. Changing epidemiology of HCC is related to trends in these risk factors, Paraneoplastic syndromes (PNS) are defined as systemic, metabolic, or other distant consequences of malignancy resulting, either directly or indirectly, from production by the neoplasm of substances that gain access to the blood stream, thereby exerting their effects on distant organs or tissues There is four major HCC-associated paraneoplastic syndromes among Cirrhotic patients,i.e.hypercholesterolemia,hypoglycemia,hypercalcemia,and erythrocytosis .

Inclusion Criteria:

• - Cirrhotic Patients with HCC.
• HCC will be diagnosed based on Alpha -feto protein (AFP) and dynamic imaging.

Exclusion Criteria:

• - Patient known to have primary parathyroid disease, patients with bone metastasis or excessive use of antacids.
• Patients with secondary polycythemia (as chronic hypoxia) and patients with polycythemia rubra vera.
• Patients with acute infections or GIT bleeding.
• Patients with preexisting dyslipidemia.
• Patients with significant cholestasis.

• Cirrhotic Patients with HCC.
• HCC will be diagnosed based on Alpha -feto protein (AFP) and dynamic imaging.