In the early stages of hepatocellular carcinoma, doctors may recommend surgical removal, a transplant, or ablation, which involves destroying tumor cells with chemicals or heat.

Generally, HCC treatment depends on factors such as the cancer stage, the tumor size, and how much function remains in the liver.

In the advanced stage, the first-line treatment is immunotherapy with a targeted therapy.

HCC refers to a primary liver tumor. Primary means it originates in the liver, unlike a secondary liver tumor, which spreads to the liver from another part of the body. It accounts for more than 9 in 10 primary liver tumors and is the fifth most common cause of cancer in the world.

Keep reading to learn more about HCC treatment, including surgery, transplant, ablation, radiation therapy, drug therapy, immunotherapy, clinical trials, and frequently asked questions.

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Doctors usually use surgery to treat liver cancer when the tumor is small and has not spread, and the person will have enough liver function remaining afterward.

Candidates for surgery include individuals with tumors less than 5 centimeters (cm) in size and those with Child–Turcotte–Pugh A, which is a classification that denotes the least severe stage of liver disease.

A person who meets the above two criteria has a 5-year survival rate of 70% and a 10-year survival rate of 35%. The risk of recurrence during 5 years is up to 70%.

Survival rates are based on information from large groups of people with the same type of cancer. They are overall survival rates. Healthcare professionals can give individual outlooks based on factors, such as age, overall health, and response to treatment.

A liver transplant involves replacing a diseased liver with a liver from a healthy donor. It offers the potential for a cure.

A criterion for transplant is having a single nodule that is 5 cm or less in diameter. Another criterion involves having no more than three nodules, with none larger than 3 cm in diameter, under certain conditions.

Someone who meets these criteria has a 5-year survival rate of 60–80% and a 10-year survival rate of 50%.

Learn more about liver transplants.

According to a 2020 review, ablation therapy offers a potential cure for early stage liver cancer. It involves destroying cancer cells by applying chemicals or heat through the skin or surgically. Doctors consider this option for people who are ineligible for surgical removal of the tumor.

One method — radiofrequency ablation (RFA) — generates heat using a high-frequency electric current. This is most effective in individuals with lesions 2 cm or smaller. According to a 2022 review, in tumors sized 2–3 cm or smaller, this treatment can achieve a complete necrosis rate of 90%. Necrosis refers to the death of body tissue.

Learn more about RFA for cancer.

In the past, doctors did not consider radiation therapy a good option because it caused injury to the liver tissue surrounding the tumor. Now, research indicates that an emerging therapy — stereotactic body radiation therapy (SBRT) — is a safer choice.

Overall survival for 1 and 2 years after SBRT is 74% and 46%, respectively, according to an older 2015 study. When the authors compared its effectiveness to RFA, they found both therapies controlled small tumors, but SBRT offered an advantage in treating tumors larger than 2 cm.

Learn more about radiation therapy for liver cancer.

Targeted therapy uses medications to target changes on a cellular level and which play a role in transforming noncancerous cells into cancer. It works differently from standard chemotherapy medications.

Some examples of targeted therapy include:

  • bevacizumab (Avastin)
  • ramucirumab (Cyramza)
  • regorafenib (Stivarga) and cabozantinib (Cabometyx)
  • sorafenib (Nexavar) and lenvatinib (Lenvima)

As the medications enter the bloodstream and reach all parts of the body, targeted therapies may help fight cancers that have spread distantly.

Immunotherapy helps the immune system fight cancer. Some examples of immunotherapy drugs include:

  • atezolizumab (Tecentriq) and durvalumab (Imfinzi)
  • pembrolizumab (Keytruda) and nivolumab (Opdivo)
  • Ipilimumab (Yervoy) and tremelimumab (Imjudo)

A 2020 review found that this therapy is safe, but single agents did not provide a survival benefit over combination therapies. When experts combine immunotherapy with other interventions — as they typically do — it may increase overall and progression-free survival.

Learn more about immunotherapy for liver cancer.

Clinical trials explore ways to find treatments that are safer or more effective. Participation in these studies is a means of getting an experimental treatment.

A person may look for a clinical trial here.

Below are answers to some FAQs about HCC:

What is the first-line treatment for hepatocellular carcinoma?

This depends on different factors. Doctors may recommend surgery, a transplant, or ablation if the cancer has not spread. For advanced cancer, a combination of immunotherapy and targeted therapy is the first-line treatment, for example, a combination of atezolizumab and bevacizumab.

How treatable is hepatocellular carcinoma?

It is more treatable in the early stages because treatments of these tumors have associations with longer-term survival. However, the overall outlook is not good, as the overall 5-year survival rate of people with this cancer is 18%.

What is the best treatment for hepatocellular carcinoma?

There is no one-size-fits-all best treatment. That said, the best outcomes typically stem from surgical removal or a transplant, but someone must meet the qualifying criteria to be eligible for these.

In the early stages, when a tumor is small, HCC treatment may include surgery, a transplant, and ablation. Conversely, after the cancer grows and spreads, a combination of immunotherapy and targeted therapy may be the gold standard treatment. This can involve a combination of atezolizumab and bevacizumab.

Other treatment options include a type of radiation therapy known as SBRT.

Since treatment in the early stages may lead to long-term survival, a person with the condition should have any doctor-recommended intervention as quickly as possible.