What Is Hepatocellular Carcinoma (HCC)?
Hepatocellular Carcinoma (HCC) is the most common form of primary liver cancer — cancer that originates in liver cells (hepatocytes). It is distinct from secondary liver cancer (metastases) where cancer spreads from other organs to the liver.
HCC is the 6th most common cancer globally and the 3rd leading cause of cancer death. In India, it is strongly linked to viral hepatitis — particularly Hepatitis B — which affects an estimated 40 million Indians. Alarmingly, most cases are diagnosed at an advanced stage because early HCC causes no symptoms.
Risk Factors — Who Is at Highest Risk?
- Liver Cirrhosis (from any cause) — the single greatest risk factor; annual HCC incidence in cirrhotics is 2–4%
- Chronic Hepatitis B — HCC can develop even without cirrhosis; lifelong antiviral therapy and surveillance required
- Chronic Hepatitis C — especially with advanced fibrosis or cirrhosis
- Alcohol-related cirrhosis
- MASLD with cirrhosis — rising incidence in urban India
- Male sex and age >40
- Aflatoxin exposure — from mouldy grains and peanuts
- Diabetes and obesity — independent risk factors
Symptoms of Liver Cancer
Early HCC is usually asymptomatic. Symptoms appear only when the tumour is large or has caused liver decompensation. This is why surveillance (not waiting for symptoms) is critical.
- Unexplained weight loss or loss of appetite
- Upper right abdominal pain or a new abdominal mass
- Worsening jaundice in a known cirrhotic patient
- Sudden decompensation (ascites, encephalopathy) in a stable cirrhotic
- Fever without clear infection
- Sudden rise in AFP (alpha-fetoprotein) on blood test
The Only Way to Catch HCC Early: Surveillance
All patients with cirrhosis or chronic Hepatitis B should undergo 6-monthly ultrasound + AFP blood test. This surveillance programme is the difference between finding a curable 2 cm tumour and an inoperable 10 cm tumour. Dr. Srinivas Bojanapu co-ordinates structured HCC surveillance for all at-risk patients at Dhaara Liver Clinic.
BCLC Staging of Liver Cancer
The Barcelona Clinic Liver Cancer (BCLC) staging system guides treatment decisions based on tumour characteristics, liver function (Child-Pugh score), and patient performance status.
Very early. Single <2 cm. Normal liver function. Curable.
Early. ≤3 nodules, each ≤3 cm. Child-Pugh A/B. Curable.
Intermediate. Multiple tumours. No vascular invasion. TACE/TARE.
Advanced. Vascular invasion or extra-hepatic spread. Systemic therapy.
Terminal. Severe liver failure. Best supportive care.
Treatment Options
| Stage | Treatment | Goal |
|---|---|---|
| Very Early / Early (0-A) | Hepatectomy or Liver Transplant or Ablation (RFA/MWA) | Curative |
| Intermediate (B) | TACE / TARE (Y-90) — "bridge to transplant" or tumour downstaging | Disease control / Bridge |
| Advanced (C) | Systemic therapy: Sorafenib, Lenvatinib, Atezolizumab + Bevacizumab | Palliative / Life extension |
| Terminal (D) | Best supportive care and symptom management | Quality of life |
Milan Criteria and Liver Transplantation
Patients within the Milan Criteria — single tumour ≤5 cm or up to 3 tumours each ≤3 cm, without vascular invasion — are excellent transplant candidates. Post-transplant 5-year survival exceeds 70%, making transplant the preferred curative option for HCC within Milan Criteria in patients with underlying cirrhosis.
TACE or TARE is used as a "bridge" to keep tumours stable while awaiting a donor organ. Dr. Srinivas Bojanapu manages the entire pathway — from TACE coordination to liver transplantation.