What is hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. The vast majority of cases develop in livers that already have chronic disease, most often cirrhosis from chronic hepatitis B, chronic hepatitis C, alcohol-related liver disease, or non-alcoholic fatty liver disease (now called metabolic dysfunction-associated steatotic liver disease).

Why the underlying liver disease matters. HCC is one of the few cancers where the health of the surrounding organ is itself a major treatment consideration. Patients with poor liver function may not tolerate aggressive therapy that would be standard in other cancers. The Child-Pugh and MELD scores assess liver function and influence which treatments are appropriate.

The surveillance pathway. People with cirrhosis are recommended to have ultrasound (often plus alpha-fetoprotein blood test) every six months to catch HCC early. Earlier detection allows curative options like resection, ablation, or transplant; late-stage detection limits options to systemic therapy. Surveillance uptake remains uneven.

The therapy options.

Early-stage HCC: surgical resection or ablation (using heat or microwave to destroy the tumour) for patients with preserved liver function. Liver transplant for patients meeting eligibility criteria, which removes both the cancer and the underlying diseased liver.

Intermediate-stage HCC: transarterial chemoembolisation (TACE) delivers chemotherapy directly to the tumour through its blood supply and blocks that supply. Transarterial radioembolisation (TARE / Y-90) uses radioactive microspheres delivered the same way.

Advanced HCC: the modern first-line is the immunotherapy atezolizumab combined with the anti-VEGF antibody bevacizumab. Durvalumab plus tremelimumab (dual immunotherapy) is an alternative. Second-line options include several oral targeted therapies and additional immunotherapy combinations.

What to expect. HCC survival has improved substantially in the past several years for patients with advanced disease, particularly with the introduction of immunotherapy combinations. For patients caught early, curative treatment is increasingly possible. Hepatitis B vaccination and hepatitis C cure (with the modern direct-acting antivirals) are also reducing HCC incidence in many regions.