Liver Cancer

Primary liver cancer arises from the cells of the liver itself, as opposed to secondary (metastatic) cancers that spread to the liver from other organs. The most common type is hepatocellular carcinoma (HCC), which accounts for 75–85% of all liver cancers and develops predominantly in the setting of chronic liver disease — particularly hepatitis B, hepatitis C, alcoholic cirrhosis, and NASH cirrhosis. Intrahepatic cholangiocarcinoma, arising from the bile duct cells within the liver, is the second most common primary liver malignancy. HCC is the fifth most common cancer worldwide and a leading cause of cancer-related death, with a rising incidence in India due to the high prevalence of viral hepatitis.

Early-stage HCC is frequently asymptomatic and detected through surveillance programmes — six-monthly ultrasound and AFP monitoring — in at-risk cirrhotic patients. Larger tumours present with right upper quadrant pain, weight loss, jaundice, and deteriorating liver function. Diagnosis is confirmed with contrast-enhanced CT or MRI, which shows the characteristic arterial phase enhancement and portal venous washout of HCC (LI-RADS 5). Staging systems such as the Barcelona Clinic Liver Cancer (BCLC) classification guide treatment selection, taking into account tumour size, number of lesions, vascular invasion, liver function, and performance status.

Treatment options for HCC include curative approaches — surgical resection (hepatectomy) for patients with adequate liver reserve, and liver transplantation for patients meeting Milan Criteria (single tumour ≤5 cm or up to 3 tumours ≤3 cm) in the setting of cirrhosis — as well as ablative therapies (radiofrequency or microwave ablation), locoregional treatments (transarterial chemoembolisation TACE, radioembolisation SIRT), and systemic therapy (sorafenib, lenvatinib, immunotherapy combinations). Our HPB and transplant surgical team at Ahmedabad Liver Surgeons offers comprehensive evaluation and expert surgical management for all stages of primary liver cancer, with a multidisciplinary tumour board approach ensuring patients receive the most appropriate treatment strategy.