Liver cancer

This guide focuses on hepatocellular carcinoma (HCC), the most common primary liver cancer in adults. Intrahepatic cholangiocarcinoma begins in bile ducts, while a colorectal or breast cancer deposit in the liver is metastatic cancer from that original site. Combined tumors and rarer types require specialist pathology review.

HCC often develops with chronic hepatitis B or C, cirrhosis, alcohol-related liver injury or metabolic liver disease. It can also occur without cirrhosis. Early disease may cause no symptoms; later problems can include right upper abdominal discomfort, reduced appetite, weight loss, jaundice or abdominal swelling. A changing symptom may reflect cancer, liver disease or both.

In defined at-risk patients, such as people with cirrhosis or certain chronic hepatitis B settings, characteristic findings on multiphase contrast CT or MRI can establish HCC without biopsy. This exception does not apply to every liver nodule or every patient. Atypical imaging, an uncertain underlying diagnosis or suspected mixed cancer may require tissue sampling.

AFP is useful in context, not as a stand-alone verdict. Some HCCs do not raise AFP, and other conditions can raise it. Imaging should document tumor number, size, vascular invasion, spread outside the liver and the condition of the background liver. Previous scans help distinguish real change from differences in technique.

Child-Pugh and ALBI are ways to describe liver reserve; they are not cancer stages. Two people with similar tumors may need different treatment because one has well-compensated liver disease and the other has recurrent ascites or encephalopathy.

HCC care commonly uses the Barcelona Clinic Liver Cancer (BCLC) framework; China also uses CNLC. These approaches combine tumor extent with liver function and performance status. TNM can describe anatomical spread, but the stage label alone is not enough to select treatment. Ask which framework is being used before comparing opinions from different centers.

The goal may be complete local treatment, control while awaiting transplant assessment, shrinkage to allow a later procedure, or longer-term disease control. These goals can change after response or deterioration in liver function. A multidisciplinary review helps align the liver and cancer priorities.

Resection may be appropriate when the tumor pattern and liver reserve allow safe removal. Thermal ablation can treat selected small tumors, particularly when surgery is unsuitable; proximity to major vessels, bile ducts or other organs can limit it. Neither tumor size nor a technically feasible procedure alone establishes the best choice.

For selected patients, transplantation can address both HCC and severe underlying liver disease. Eligibility includes tumor behavior and extent, general health and the applicable transplant criteria. Donor access, allocation rules and assessment requirements vary by jurisdiction. Evaluation does not establish that transplantation is available or appropriate for an individual.

Transarterial chemoembolization (TACE) delivers treatment through tumor-feeding arteries and reduces their blood supply. Radioembolization uses radioactive microspheres, often yttrium-90 (Y-90); mapping assesses arterial anatomy, delivery to unintended organs and radiation reaching the lungs. External-beam radiation can be useful in selected situations. Liver reserve and the volume of liver exposed matter for each approach.

Hepatic arterial infusion chemotherapy (HAIC) is used in selected regional pathways, including China's current guidance for some patients with substantial intrahepatic disease or vascular invasion. Its role depends on liver function, prior treatment and center expertise. It should not be presented as a universal replacement for systemic therapy.

Repeated local procedures should have a clear purpose. If response is poor or liver function is declining, ask whether another procedure still helps or whether the overall strategy should change.

Systemic therapy is considered when disease is advanced, unsuitable for local treatment or progressing despite it. Options depend on previous therapy, liver function, bleeding risk, autoimmune conditions and any transplant history. Much of the strongest trial evidence comes from people with preserved liver function; results cannot simply be transferred to severely decompensated cirrhosis.

• In the United States, atezolizumab plus bevacizumab is approved for adults with unresectable or metastatic HCC without prior systemic therapy. Varices and bleeding risk need assessment before this strategy.
• Durvalumab plus tremelimumab has a US indication for adults with unresectable HCC.
• Nivolumab plus ipilimumab has a US first-line indication for adults with unresectable or metastatic HCC.

These regimens are alternatives to evaluate, not combinations to mix together. Oral targeted drugs remain relevant when immune treatment is unsuitable and in later treatment sequences. New diarrhea, breathlessness, jaundice or unusual weakness during immunotherapy needs prompt clinical contact because immune effects can involve organs beyond the tumor.

After complete treatment, imaging follow-up remains important because HCC can recur and the background liver may remain at risk. A new lesion should prompt reassessment of its location, vascular involvement, liver reserve and prior treatment. Some recurrences can still be treated locally; others require systemic treatment or a different care goal.

Treatment after curative-intent resection or ablation is not automatically the same as treatment for unresectable HCC. AASLD's critical update advises against routine neoadjuvant or adjuvant systemic therapy in this setting. China's 2026 guidance discusses selected high-risk perioperative approaches while noting that a standard adjuvant regimen remains unsettled. Ask which evidence, risk group and regional recommendation supports a proposed plan.

GPC3-directed CAR T-cell therapy is a research direction for HCC, with early clinical studies including engineered approaches designed to work within the tumor environment. A GPC3-positive result alone does not establish benefit or suitability. These studies assess safety and activity in selected patients; their results should not be treated as proof of a routine option for every liver cancer.

The phase I RPCAR01 study, NCT06968195, is one example of how eligibility can include prior treatment, tissue expression, liver function and viral-hepatitis control. The NCI listing was temporarily closed to accrual at this page's update. A trial listing is a research reference, not a promise of an available place.

Hepatitis management, cirrhosis care and nutrition continue alongside cancer treatment. Review antiviral medicines, alcohol use, supplements and potential drug interactions with the team. Avoid starting 'liver-protective' products without checking their ingredients and safety. Maintaining intake and muscle strength can be important even when fluid accumulation makes body weight appear stable.

Vomiting blood, black stools with faintness, new confusion, rapidly worsening abdominal swelling or fever with abdominal pain needs urgent assessment. These can be complications of liver disease as well as cancer. Supportive and palliative care can help with pain, fatigue, itching and family needs throughout treatment.

• Original multiphase CT/MRI and prior studies, not only screenshots or a summary.
• Pathology if obtained, AFP trends, blood counts, bilirubin, albumin, coagulation and kidney function.
• Hepatitis results and antiviral history; ascites, encephalopathy, varices or previous bleeding records.
• The full history of surgery, ablation, embolization, radiation and systemic treatment, with response and complications.

Ask: Which issue currently limits treatment—tumor extent or liver reserve? Is there a meaningful local option? What would trigger a switch in strategy? How will both cancer response and liver function be monitored?