Hepatocellular carcinoma, or HCC liver cancer, is the most common type of liver cancer. HCC develops from liver cells and is more likely to develop in a liver with scarring from infection.

Scarring of the liver is known as cirrhosis. Common infections that cause liver scarring include hepatitis B and hepatitis C. Excessive alcohol consumption can also cause liver scarring.

In this article, we examine HCC liver cancer and its causes. We also look at the symptoms of the condition and potential treatment options.

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HCC is the most common type of primary cancer that occurs in the liver. This is a term to describe the original, or first, tumor present in the body. It arises from hepatocytes (liver cells). A liver often has scarring from a disease, condition, or excessive alcohol consumption and then develops a tumor.

Liver cancer is typically treatable depending on the stage and size of the cancer. Treatment may also depend on whether the cancer has spread elsewhere.

A person with early liver cancer may not have any symptoms. Some indicators of liver cancer may also suggest other conditions, so doctors may rule out these conditions before suspecting liver cancer.

Symptoms of HCC may include:

A person should talk with a healthcare professional if they experience any of the above symptoms.

Factors that may increase a person’s risk of developing liver cancer include:

Doctors diagnose liver cancer through a series of tests:

  • Medical history: Doctors take a medical history, which includes asking questions about health habits and past treatments of illnesses.
  • Physical examination: Doctors check a person’s body for unusual lumps.
  • Alpha-fetoprotein (AFP) tumor marker test: Doctors use the AFP tumor marker test to check for a protein called AFP. A high level of AFP could be a sign of liver cancer or other conditions.
  • Liver function test: This test checks the overall health and function of the liver.
  • Ultrasound exam: This uses sound waves to make a sonogram, or sound picture, of the liver.
  • CT scan: This procedure creates detailed images of areas inside the body, such as the abdomen. A CT scan may involve the injection of dye to highlight internal organs.
  • MRI scan: This scan creates detailed images of body areas such as the liver. Healthcare professionals may use dye to highlight areas.
  • Biopsy: This procedure removes tissue or cells for a laboratory to check for cancer.

If a doctor diagnoses liver cancer, tests such as MRI and CT scans may help determine the cancer’s stage. A PET scan may also help.

Doctors typically use the American Joint Committee on Cancer TNM system to stage liver cancer. This system uses three key pieces of information:

  • Tumor size (T): A doctor will check how large the cancer is and whether there is more than one tumor present in the liver.
  • Node spread (N): They will also check whether the cancer has spread to any nearby lymph nodes.
  • Metastasis (M): Additionally, they will test to determine whether the cancer has spread to distant organs, such as the bones or lungs.

This system also combines numbers and letters after T, N, and M to provide more information about each of these factors. For example, higher numbers mean the cancer is more advanced. Through a process known as stage grouping, a doctor can use these details to assign an overall stage.

Doctors may also use the Barcelona Clinic Liver Cancer (BCLC) staging system to stage liver cancer. The system predicts a person’s outlook for recovery and enables doctors to plan treatment according to the cancer stage. The BCLC uses five stages:

Stage State of cancer
0extremely earlyLocalized: removal through surgery.
AearlyLocalized: removal through surgery.
BimmediateLocalized: removal through surgery.
CadvancedLocally advanced. It may not be safe to remove through surgery.
Dend stageMetastatic cancer that spreads from the liver to other parts of the body. Surgery may not remove it entirely.

It is important to note that liver cancer may return following treatment. This is known as recurrent liver cancer.

If liver cancer is localized, doctors may closely monitor a person’s condition, known as surveillance, and regularly perform certain exams and tests. Treatment may include surveillance if the lesion is less than 1 centimeter across.

Ablation therapy

Ablation therapy destroystumor cells using a probe. Doctors use this technique for tumors they cannot remove easily with surgery.

Types of ablation therapy include:

  • Radiofrequency: A doctor inserts needles that are heated by radio waves through an incision in the abdomen to kill the cancer cells.
  • Microwave: Microwaves create high temperatures that damage and kill cancer cells or ensure they respond to radiation and anticancer drugs.
  • Percutaneous ethanol injection: A healthcare professional injects pure alcohol (ethanol) into the tumor to destroy the cancer cells.
  • Cryoablation: A doctor freezes the cancer cells using a specialized instrument. This destroys them.
  • Electroporation: An electrode placed on a tumor sends electric pulses to kill the cancer cells.

Complications of ablation therapy are rare. However, side effects may include:

Targeted therapy

Targeted therapy uses drugs that attack specific cancer cells. This type of therapy may cause less harm to healthy cells.

Targeted therapy works by:

  • destroying cancer cells using the immune system
  • disrupting cancer cells when they are changing and growing
  • reducing or stopping blood vessels that enable a tumor to grow bigger
  • delivering toxic substances to tumor cells
  • enabling cancer cells to die the same way healthy cells can
  • preventing the production of hormones that feed cancer cells

Targeted therapy is only available for certain types of cancer cells.

Side effects of targeted therapy may include:

Complications of targeted therapy may include:

Embolization therapy

Embolization therapy uses substances to decrease or block the blood flow to a tumor. Reducing blood flow to tumor cells is possible without significantly affecting the liver cells.

Doctors may recommend embolization for people with tumors too large for surgery or ablation. However, the therapy may not work for people with liver damage.

There are different types of embolization:

  • Transarterial embolization (TAE): A doctor feeds a catheter through an artery in the inner thigh to the hepatic artery in the liver. They inject a substance into the artery to block blood flow from the tumor.
  • Transarterial chemoembolization (TACE): This procedure is similar to TAE. However, it uses chemotherapy drugs. The chemotherapy stays next to the tumor, and only small amounts of the drug reach elsewhere.
  • Drug-eluting bead chemoembolization: This procedure combines TACE with tiny beads containing chemotherapy drugs. The beads slowly release the chemotherapy drugs into the cancer cells.
  • Radioembolization: A doctor gives a person small doses of radiation that travels a short distance to the tumor. Smaller doses of radiation have a lower risk of the radiation damaging healthy cells.

Side effects and complications of embolization therapy may include:

  • abdominal pain
  • nausea
  • fever
  • liver infection
  • blood clots in liver blood vessels


Immunotherapy medication enables a person’s immune system to target cancer cells. Some people with liver cancer may benefit from this type of therapy.

Cancer cells can use the body’s defenses to hide from a person’s immune system. Immunotherapy enables the body to find the cancer cells and target them.

People receive immunotherapy as an IV infusion at regular intervals.

Side effects of immunotherapy may include:


Doctors may recommend chemotherapy when other therapies such as ablation, embolization, or targeted therapy are not helpful, and surgery is not an option.

Doctors may give a combination of two or three chemotherapy drugs. Examples of chemotherapy drugs for treating HCC include:

  • sorafenib, also available as the brand-name drug Nexavar
  • lenvatinib, also available as the brand-name drug Lenvima
  • regorafenib


A doctor may recommend surgery if the liver has a single tumor that does not impact blood vessels.

Surgery removes cancer and a small section of the surrounding healthy tissue. The remaining tissue takes over the functioning of the liver, and the area removed during surgery can regrow.

Side effects and complications of liver surgery may include:

Liver transplant

According to a 2020 study, a transplant can effectively treat HCC liver cancer. Doctors may suggest a liver transplant if a person’s liver is not responding to treatment or has sustained significant damage.

A person may receive a transplant from a deceased donor or a part of a liver from a living donor. A living donor is typically a close relative.

One risk of a liver transplant may include the rejection of the new liver. A person who receives a liver transplant must take medication to help prevent this for the rest of their life.

A person’s 5-year survival rate after a liver cancer diagnosis depends on many factors, such as their general health, liver health, and the stage of liver cancer they have. For HCC liver cancer, the survival rate is typically higher for people who receive surgery.

Across all stages of liver cancer, 20% of people will live for 5 years after diagnosis. However, the earlier someone receives treatment, the more likely it is that they will live for 5 years after diagnosis.

Statistics show estimates based on generalizations and cannot predict what will happen to a specific person.

HCC liver cancer is a condition that can be challenging to detect in the early stages. However, early diagnosis gives a person the best possible outlook.

A person who has liver cancer should follow their healthcare team’s advice and keep treatment appointments. They may also wish to research the condition.

To help lower the risk of liver cancer, a person can reduce their exposure to the known risk factors of the disease.

Many treatments are available depending on the stage of cancer and the individual.

Support groups can provide information and assistance for people with HCC liver cancer, their family, and friends.