Understanding Liver Cancer (HCC)
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 75–85% of liver cancer cases. India has rising HCC rates driven by the high prevalence of Hepatitis B, Hepatitis C, and NAFLD-related cirrhosis. Early-stage HCC is potentially curable — this is why regular surveillance in cirrhotic patients is critical.
At Dhaara Speciality Hospital, Dr. Srinivas Bojanapu — HPB (Hepato-Pancreato-Biliary) Surgeon and Liver Transplant trained specialist — leads our liver cancer management team, providing staging workup, surgical resection, ablation guidance, TACE coordination, and liver transplant evaluation.
Risk Factors for Liver Cancer
High-Risk Conditions
- Liver cirrhosis (any cause) — 80% of HCC arises in cirrhotic livers
- Chronic Hepatitis B (even without cirrhosis)
- Chronic Hepatitis C with cirrhosis
- NAFLD/NASH cirrhosis — rapidly rising
- Alcoholic cirrhosis
- Aflatoxin exposure (contaminated grains)
Other Risk Factors
- Haemochromatosis (iron overload)
- Alpha-1 antitrypsin deficiency
- Diabetes and obesity
- Family history of liver cancer
- Male sex (3:1 male predominance)
- Age >50 years
Surveillance: Catching Cancer Early
All cirrhotic patients and HBV carriers without cirrhosis (with high viral load or family history) should undergo 6-monthly surveillance:
- Ultrasound abdomen — primary surveillance tool; 60–80% sensitive for HCC
- Serum AFP (Alpha-fetoprotein) — tumour marker; elevated in 60–70% of HCC (not specific)
- If nodule detected on ultrasound → CT triple phase or MRI with gadoxetate for characterisation
Key fact: Early HCC (<3 cm, single nodule, good liver function) has a 5-year survival of 60–70% with resection or transplant. Late HCC with portal vein invasion or extrahepatic spread has a median survival of 6–11 months even with systemic therapy. Surveillance is life-saving.
Staging: BCLC System
| BCLC Stage | Characteristics | Recommended Treatment |
|---|
| 0 — Very Early | Single <2 cm, Child A, PS 0 | Resection or ablation (RFA/MWA) |
| A — Early | Single or 3 nodules ≤3 cm, Child A/B | Resection, transplant, or ablation |
| B — Intermediate | Multinodular, no vascular invasion, PS 0 | TACE (Transarterial Chemoembolisation) |
| C — Advanced | Portal vein invasion or extrahepatic spread | Sorafenib, Lenvatinib, Atezolizumab+Bevacizumab |
| D — Terminal | Very poor liver function, Child C | Best supportive care |
Treatment Options
Curative Treatments
Surgical Resection: Removal of the tumour-bearing liver segment. Best option for single tumours in non-cirrhotic liver, or selected cirrhotic patients with good liver function (Child A, adequate future liver remnant). 5-year survival 50–70%. Dr. Srinivas Bojanapu performs laparoscopic and open liver resections.
Liver Transplantation (Milan Criteria): For patients with single HCC ≤5 cm, or up to 3 nodules all ≤3 cm, with cirrhosis. Transplant removes both the cancer and the underlying cirrhosis. 5-year survival 65–75%. Patients exceeding Milan criteria may be downstaged with TACE first.
Learn about liver transplant →
Radiofrequency Ablation (RFA) / Microwave Ablation (MWA): Heat energy delivered through a needle directly into the tumour, destroying it. Best for small HCC (<3 cm) in patients unfit for surgery. Comparable outcomes to surgery for very small HCC. Can be performed percutaneously (ultrasound-guided), laparoscopically, or during open surgery.
Non-Curative / Palliative Treatments
TACE (Transarterial Chemoembolisation): Chemotherapy drug (doxorubicin) delivered directly into the artery supplying the tumour, followed by embolic particles cutting off blood supply. Used for intermediate-stage (BCLC B) HCC. Significantly prolongs survival. Also used to downstage tumours to curative intent.
SIRT (Selective Internal Radiation Therapy / Y-90 Radioembolisation): Radioactive microspheres (Yttrium-90) delivered into the hepatic artery. Alternative to TACE for some patients. Effective for patients with portal vein involvement.
Systemic Therapy: Sorafenib (standard first-line), Lenvatinib, or Atezolizumab + Bevacizumab (superior outcomes in recent trials) for advanced HCC. Second-line: Regorafenib, Cabozantinib, Ramucirumab (AFP >400).
Frequently Asked Questions
Can liver cancer be cured?
Early-stage liver cancer (BCLC 0/A) can be cured with surgical resection, transplantation, or ablation — with 5-year survival rates of 50–75%. The key is early detection through regular surveillance in at-risk patients (cirrhotics, HBV carriers). Advanced HCC cannot be cured but survival can be extended with systemic therapy.
I have cirrhosis — how often should I have surveillance?
Every 6 months with liver ultrasound + AFP. This is non-negotiable — annual surveillance misses 30–40% of HCCs that grow to unresectable size between annual scans. 6-monthly surveillance is the international standard and detects most HCCs at an early, treatable stage.
What are the symptoms of liver cancer?
Early HCC typically causes NO symptoms — it is detected on surveillance. Symptomatic HCC (right upper abdominal pain, weight loss, jaundice, ascites) is usually advanced. This reinforces the critical importance of surveillance in cirrhotic patients and HBV carriers.
Liver Cancer Surgery — Specialist Information
For detailed information on liver cancer surgery options — laparoscopic liver resection, hepatectomy, and surgical candidacy in Bangalore — visit Dr. Srinivas Bojanapu's specialist website.
Liver Cancer Surgery — Dr. Srinivas Bojanapu ›