Liver cancer

HCC–Hepatocellular Carcinoma

Did you know?

Men are three time likely to get liver cancer.
Liver cancer is a type of cancer that starts in the liver.
Cancer starts when cells in the body begin
to grow out of control. Liver cancer stages
from early to advanced stage.
There are different treatment options
at different stages.

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Dr. Sachin Modi – BSc (Hons), MBBS, FRCR(IR) Consultant Interventional Radiologist University hospital Southampton. South Hampton, Hampshire, United Kingdom.

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Treatment options

Treatment of HCC depends on tumor size, number of tumors, liver function and patients’ overall health status.
All these elements below are based on the EASL 20181 and ESMO 2020 recommendations which assist physicians, healthcare providers, patients and other interested parties in the clinical decision-making process. The EASL and ESMO Guidelines present a range of state-of-the-art approaches for the diagnosis and treatment of liver diseases.

There are several options to treat liver cancer. In some cases, more than one type of treatment could be used to get the best outcome. Any patient should be followed by a referral doctor while the treatment allocation decision making should be performed through a multidisciplinary team (hepatologists, surgeons, interventional radiologists, oncologists and radiotherapists).



If liver cancer is suspected, notably at-risk people (hepatitis B/C, alcohol, metabolic disorders…),
test should be regularly performed:
-Ultra sound examination: to detect suspect lesions
-Blood tests: to detect liver impairment



Liver cancer is the unique cancer where diagnosis is established based on imaging examination
-Magnetic resonance imaging (MRI) enhanced with gadolinium-based contrast medium is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body
-Computed tomography (CT) enhanced with iodinated contrast medium scan uses computer and rotating X-ray machines to create detailed images of the liver
-A biopsy could be performed If imaging is not conclusive

Patient follow up:
MRI & CT can be used to evaluate treatment response, and cancer progression
within 4-6 weeks following the treatment and then 3-6 months for patient follow up

Treatment options


Decision allocation making depends on cancer staging (early, intermediate and advanced stage)

-Surgery: Surgical resection for early diagnosed liver cancer without extra hepatic extension.

-Liver transplantation: Option for small tumors without extra hepatic extension.
Transplantation of a liver portion or of a whole liver

-Thermal destruction: With ultrasound guidance, we insert probes through the liver tissue near the tumor. This probe delivers high frequency alternating electrical current precisely at the site of the tumor. Cryoablation under the guidance of many imaging methods can induce ice ball formation and tumor necrosis

-Transarterial chemoembolization(TACE) is a minimally invasive technique treatment that is performed in an operating room by an interventional radiologist. It consists of a selective and targeted therapy enabling both the injection of anti-cancer drug into the tumor and stopping the tumor blood flow leading to the lesion shrinkage over the time. During TACE, X-ray guidance is used to navigate a delivery tool (microcatheter) into the hepatic arteries, via a pinhole in the wrist or groin

-Chemotherapy intravenous or oral route. There are two classes of chemotherapy TKI
(tyrosine kinase inhibitor) and immune therapies

-Radiation therapy: external (SBRT) or internal (SIRT)

Want to go further on Hepatocellular Carcinoma (HCC)?
Let ESMO guidelines answer some of your questions.

You can get further information on the HCC via ESMO Patient Guide Series


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