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.