Liver Cancer (Hepatocellular Carcinoma)

Hepatocellular carcinoma (HCC) is the most common liver cancer accounting for approximately 90% of all cancers arising in the liver. As per estimates of World Health Organization, it is the fifth most common cancer and third leading cause of cancer related deaths worldwide. Recent ICMR data estimated HCC to be fourth and eighth leading cause of cancer related deaths among Indian men and women respectively.


HCC often does not cause any specific symptoms until late stages – the tumor is usually detected during investigations for cirrhosis. Outside screening programs, patients often present with symptoms of advanced cirrhosis – unexplained weight loss, loss of appetite, nausea or vomiting, enlarged liver or spleen, pain in abdomen, swelling or fluid in the abdomen, abnormal veins over the belly, itching all over the body or yellowing of skin & eyes.

Patients considered at high risk of developing HCC include: cirrhosis, chronic hepatitis B or C.

HCC is usually diagnosed by a combination of increased levels of tumor marker alpha-fetoprotein (AFP) and characteristic image findings of triple phase CT scan of the liver. MRI may be indicated where doubt remains in diagnosis.

Routine needle biopsy is not recommended for confirmation of HCC as it may lead to spread of cancer cells along the needle track. However, biopsy may be indicated in select patients where diagnosis is in doubt based on imaging findings.

AFP is used as tumor marker for HCC. Although AFP may be elevated in other conditions also such as liver disease, other cancers and pregnancy, but it remains useful for HCC screening and in follow up of HCC patients to assess response to the treatment.

Since majority of patients with HCC have underlying liver cirrhosis, treatment and outcomes depend on:

–      degree of liver dysfunction

–      tumor size, number and distribution

–      general health of the patient (i.e. performance status).

TNM staging widely used for other digestive tract cancers is considered inadequate for HCC and Barcelona (BCLC) staging system is widely used for the purpose.

Treatment algorithms are based on aforementioned factors and related staging systems (BCLC staging or any other staging used by your doctor). The various available treatment options include: curative and non:

–      Surgery for liver cancer: Hepatectomy / Liver transplantation

–      Ablation – Radiofrequency / Microwave ablation

Transarterial embolization – TACE / TARE

Radiotherapy – SBRT

Molecular targeted therapy

Liver transplant is effective treatment for HCC because it offers treatment for both the HCC and underlying liver disease. LT is associated with 5-year overall survival rates of 75%.However the limitation of LT is the shortage of liver graft and life-long immunosuppression.

On the other hand 5-year overall survival rate with curative hepatic resection is approx. 30%.