Liver Tumors & Metastases

Hepatocellular Carcinoma (HCC)

The most common primary liver cancer — arising from the liver cells themselves, usually in the setting of chronic liver disease or cirrhosis.

Primary Liver Cancer

Understanding HCC

HCC most commonly develops in patients with cirrhosis (from hepatitis B, hepatitis C, alcohol-related liver disease, NAFLD/NASH, or other causes). Management must account for both the tumor and the underlying liver function.

Surgical resection — For patients with localized HCC and adequate liver function (normal or Child-Pugh A). Future liver remnant calculation is essential.
Liver transplantation — For patients within Milan criteria (single tumor ≤5 cm or ≤3 tumors each ≤3 cm). Offers both tumor treatment and cure of the underlying cirrhosis.
Locoregional therapy — TACE, TARE (Y-90), and ablation are used for patients not suitable for resection or as a bridge to transplantation.

Hepatic Resection

The Surgery

Liver surgery ranges from minor resections (wedge, single segment) to major hepatectomies (removal of 3 or more segments). The extent of resection is planned using volumetric CT analysis to ensure adequate future liver remnant.

Future Liver Remnant (FLR): The volume of liver that will remain after surgery must be sufficient to support liver function. In a normal liver, a FLR of ≥20% is generally adequate. In a cirrhotic or chemotherapy-damaged liver, ≥40% may be required. Portal vein embolization (PVE) can be performed to grow the future remnant before surgery when needed.

FAQ

Frequently Asked Questions

What is hepatocellular carcinoma (HCC)?
HCC is the most common primary liver cancer — it arises from the liver cells themselves rather than spreading from another organ. It most often develops in the setting of chronic liver disease or cirrhosis, including from hepatitis B, hepatitis C, alcohol-related liver disease, or fatty liver disease (NAFLD/NASH).
Can hepatocellular carcinoma be cured with surgery?
Yes. For patients with localized HCC and adequate liver function, surgical resection can be curative. For selected patients with cirrhosis and smaller tumors, liver transplantation treats both the cancer and the underlying liver disease. The right approach depends on the size and number of tumors, their location, and how well the liver is functioning.
When is liver transplantation used for HCC?
Liver transplantation is considered for patients within the Milan criteria (a single tumor up to 5 cm, or up to 3 tumors each 3 cm or smaller) who have cirrhosis. Transplantation removes both the tumor and the diseased liver, addressing the cancer and the underlying cause at once. Locoregional therapies may be used to control the tumor while awaiting transplant.

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