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Liver Cancer (Hepatocellular Carcinoma) — Diagnosis and Modern Treatment

Comprehensive overview of primary liver cancer, predominantly hepatocellular carcinoma (HCC), including risk factors, screening protocols, BCLC staging-based treatment algorithms, and emerging immunotherapy combinations.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Liver Cancer (Hepatocellular Carcinoma) — Diagnosis and Modern Treatment?

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, arising from hepatocytes in a background of chronic liver disease in over 80% of cases. The pathogenesis involves a complex interplay of chronic inflammation, regenerative hyperplasia, dysplastic nodule formation, and accumulation of genetic alterations affecting telomerase (TERT promoter), CTNNB1 (β-catenin), TP53, and chromatin-modifying genes.

Other primary liver cancers include intrahepatic cholangiocarcinoma (10-15%, arising from biliary epithelium with distinct molecular alterations including FGFR2 fusions and IDH1/2 mutations), combined hepatocellular-cholangiocarcinoma, fibrolamellar HCC (younger patients without cirrhosis, characterized by DNAJB1-PRKACA fusion), and rare entities such as hepatoblastoma in pediatric populations. Secondary metastatic involvement is far more common than primary liver malignancy.

Diagnosis is established through multiphasic contrast-enhanced CT or MRI demonstrating characteristic arterial-phase hyperenhancement with delayed-phase washout, applying LI-RADS criteria. AFP elevation supports the diagnosis but lacks sensitivity. Staging utilizes the BCLC system integrating tumor burden, liver function (Child-Pugh), and performance status to guide stage-specific treatment. Curative options (resection, ablation, transplantation) are reserved for early-stage disease, while intermediate stage receives transarterial chemoembolization, advanced stage receives systemic therapy.

Symptoms

Right upper quadrant abdominal pain or fullness
Unexplained weight loss and decreased appetite
Abdominal distension from ascites
Jaundice with yellowing of skin and sclera
Easy bruising or bleeding from coagulopathy
Hepatic encephalopathy with confusion (advanced disease)
Many early HCCs are asymptomatic, detected through screening

Risk Factors

Chronic hepatitis B virus infection (especially with active replication)
Chronic hepatitis C virus infection (even after cure with DAAs)
Cirrhosis from any cause (alcoholic, viral, autoimmune, biliary)
Metabolic dysfunction-associated steatotic liver disease (MASLD/MASH)
Aflatoxin B1 exposure (contaminated grains, peanuts in endemic areas)
Hereditary hemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease
Obesity, type 2 diabetes mellitus, and metabolic syndrome

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Surveillance ultrasonography every 6 months in cirrhosis or chronic HBV
  • New onset of right upper quadrant pain or palpable liver mass
  • Decompensation of previously stable cirrhosis (ascites, encephalopathy)
  • Rising alpha-fetoprotein levels on routine monitoring
  • Suspicious liver lesion identified on imaging
  • Unexplained weight loss with chronic liver disease
  • Worsening jaundice or coagulopathy

Treatment Methods

01
Surgical resection for solitary tumors with preserved liver function
02
Liver transplantation within Milan criteria (single tumor ≤5 cm, or up to 3 tumors ≤3 cm)
03
Radiofrequency or microwave ablation for small early-stage tumors (<3 cm)
04
Transarterial chemoembolization (TACE) for intermediate stage BCLC-B
05
Selective internal radiation therapy (SIRT/Y90 radioembolization)
06
First-line systemic therapy: atezolizumab-bevacizumab or tremelimumab-durvalumab
07
Second-line tyrosine kinase inhibitors (lenvatinib, regorafenib, cabozantinib)

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.