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PubMed This is a summary of 134 peer-reviewed journal articles Updated
Oncology · Hepatocellular Carcinoma

Understanding Your Diagnosis: Adult Hepatocellular Carcinoma

At a Glance

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Modern care utilizes multidisciplinary teams and advanced imaging that often allows for a definitive diagnosis without a biopsy. New systemic and immunotherapy treatments have significantly expanded options for patients.

Receiving a diagnosis of Hepatocellular Carcinoma (HCC)—the most common type of primary liver cancer—is often a moment of intense panic and confusion [1]. It is natural to feel overwhelmed, especially if you were unaware of any underlying liver issues. However, understanding the facts about this disease can help replace fear with a clear plan of action.

Three Stabilizing Facts

When you are first diagnosed, it is easy to focus on the worst-case scenarios. Here are three evidence-based reasons to feel empowered:

  1. More Treatment Options Than Ever Before: The landscape of HCC treatment has expanded rapidly. New systemic therapies (drugs that work throughout the entire body), particularly combinations of immunotherapy (treatments that help your immune system fight cancer), have significantly improved long-term outcomes [2][3].
  2. Expert Teams Work Together: Modern HCC care is “multidisciplinary.” This means a team of experts—including hepatologists (liver doctors), oncologists (cancer doctors), and surgeons—collaborates to create a customized plan for you, which has been shown to improve patient survival [4].
  3. Diagnosis is Highly Precise: Unlike many other cancers, HCC can often be definitively diagnosed using advanced imaging (like a specific type of MRI or CT scan) without the need for an invasive biopsy, allowing treatment to begin more quickly [5][6].

What is Hepatocellular Carcinoma?

HCC is a cancer that begins in the hepatocytes, which are the main functional cells of the liver [7]. It is currently the 6th most common cancer worldwide [7]. The incidence is increasing globally, largely because the risk factors that cause it are becoming more common [7][8].

The Shifting Causes of Liver Cancer

For many years, HCC was primarily associated with viral infections like Hepatitis B or Hepatitis C. While these remain significant, the “face” of the disease is changing [9][8].

  • The Rise of Metabolic Factors: A growing number of cases are now linked to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as NAFLD or “fatty liver disease” [9][10]. This is often tied to conditions like obesity and type 2 diabetes [7][11].
  • The Stigma of Liver Cancer: A common misunderstanding is that liver cancer only happens to people who drink heavily. In reality, while alcohol is a major risk factor, many people develop HCC due to metabolic issues or viral infections they may not even know they have [8].
  • Cirrhosis and Risk: Most HCC occurs in a liver that has cirrhosis (advanced scarring) [12]. However, research shows that in cases related to MASLD (fatty liver), cancer can sometimes develop even before advanced scarring is present [13][14].

What Science Currently Tells Us

Medical research is very clear on certain aspects of HCC, while others are still being explored:

What We Know What is Still Being Researched
Surveillance Saves Lives: Regular screening of high-risk patients (those with cirrhosis) allows for earlier detection and much better survival rates [12][15]. Non-Cirrhotic Screening: Researchers are still working to determine exactly which patients with “fatty liver” but no cirrhosis need regular screening [16][17].
Combination Therapy Works: Using two different types of drugs (like atezolizumab and bevacizumab) is often more effective than using just one for advanced cases [18][2]. Personalized Markers: Scientists are looking for better “biomarkers” (blood tests) to predict exactly which treatment will work best for an individual patient’s specific tumor [3].

Navigating Your Guide

This resource is designed to help you understand every aspect of your diagnosis.

01

Recognizing Symptoms and Warning Signs of HCC

Learn to recognize early warning signs and symptoms of Hepatocellular Carcinoma (HCC). Understand the difference between tumor signs and liver failure symptoms.

02

The Biology of HCC: Identifying the Correct Condition

Learn how doctors diagnose Hepatocellular Carcinoma (HCC) and rule out other liver tumors. Understand tumor markers like AFP, biopsies, and imaging tests.

03

Navigating Your Stage: The BCLC System

Learn how the BCLC staging system is used for Hepatocellular Carcinoma (HCC). Understand how tumor size, liver function, and your health guide treatment.

04

Deciphering Your Liver Imaging and Pathology Reports

Learn how to read your liver cancer imaging and pathology reports. Understand LI-RADS 5 criteria, microvascular invasion, and what your results mean.

05

Navigating Your Treatment: Strategies for HCC

Learn about hepatocellular carcinoma (HCC) treatment options based on your BCLC stage. Understand resection, liver transplant, TACE, and newer immunotherapies.

06

Building Your Care Team: Preparing for Your First Visit

Learn how to build a multidisciplinary care team for hepatocellular carcinoma (HCC). Find out what records to bring to your first visit and questions to ask.

07

Life After Treatment: Surveillance and Survivorship

Learn what to expect after Hepatocellular Carcinoma (HCC) treatment. Understand your surveillance schedule, recurrence risks, and how to manage scanxiety.

08

Understanding Your Outlook: Prognosis and Risk Models

Learn how doctors predict your Hepatocellular Carcinoma (HCC) prognosis. Understand Child-Pugh, ALBI grades, AFP levels, and what they mean for your care.

Common questions in this guide

Can hepatocellular carcinoma be diagnosed without a biopsy?
Yes, unlike many other cancers, HCC can often be definitively diagnosed using advanced imaging, such as specific types of MRI or CT scans. This allows your medical team to bypass an invasive biopsy and begin treatment more quickly.
What causes hepatocellular carcinoma?
While viral infections like Hepatitis B and C remain significant causes, a growing number of HCC cases are now linked to metabolic factors. Conditions like fatty liver disease (MASLD), obesity, and type 2 diabetes are increasingly responsible for new diagnoses.
What is a multidisciplinary team for HCC?
A multidisciplinary team consists of various specialists, including liver doctors (hepatologists), cancer doctors (oncologists), and surgeons. They collaborate to create a customized treatment plan tailored to your specific tumor and overall liver health.
Do I have to have cirrhosis to get liver cancer?
While most hepatocellular carcinoma occurs in a liver that has advanced scarring known as cirrhosis, it is not an absolute requirement. In cases related to fatty liver disease, cancer can sometimes develop before advanced scarring is present.
Why is my Child-Pugh score important?
The Child-Pugh score measures how well your liver is currently functioning. This is a critical factor that helps your care team determine which liver cancer treatments are safest and most appropriate for your specific situation.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my BCLC stage and how does it affect my treatment options?
  2. 2.What is my Child-Pugh score, and how well is my liver functioning right now?
  3. 3.Based on my imaging results, do I have a 'LI-RADS 5' diagnosis, or is a biopsy necessary?
  4. 4.Is my HCC related to a past virus, metabolic factors like fatty liver, or another cause?
  5. 5.Can you walk me through the multidisciplinary team that will be involved in my care?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    Evolving Global Etiology of Hepatocellular Carcinoma (HCC): Insights and Trends for 2024.

    Koshy A

    Journal of clinical and experimental hepatology 2025; (15(1)):102406 doi:10.1016/j.jceh.2024.102406.

    PMID: 39346785
  2. 2

    New advances in the diagnosis and management of hepatocellular carcinoma.

    Yang JD, Heimbach JK

    BMJ (Clinical research ed.) 2020; (371()):m3544 doi:10.1136/bmj.m3544.

    PMID: 33106289
  3. 3

    Overcoming Resistance to Immune Checkpoint Blockade in Liver Cancer with Combination Therapy: Stronger Together?

    Werner W, Kuzminskaya M, Lurje I, et al.

    Seminars in liver disease 2024; (44(2)):159-179 doi:10.1055/a-2334-8311.

    PMID: 38806159
  4. 4

    Progress in systemic therapy of advanced hepatocellular carcinoma.

    Gong XL, Qin SK

    World journal of gastroenterology 2016; (22(29)):6582-94 doi:10.3748/wjg.v22.i29.6582.

    PMID: 27547002
  5. 5

    Role of liver biopsy in hepatocellular carcinoma.

    Di Tommaso L, Spadaccini M, Donadon M, et al.

    World journal of gastroenterology 2019; (25(40)):6041-6052 doi:10.3748/wjg.v25.i40.6041.

    PMID: 31686761
  6. 6

    Diagnosis of the Initial Stage of Hepatocellular Carcinoma: A Review.

    Sharma KK, Mohsin M, Mittal P, et al.

    Current pharmaceutical design 2024; (30(22)):1708-1724 doi:10.2174/0113816128298875240321073907.

    PMID: 38797901
  7. 7

    Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma.

    Younossi ZM, Henry L

    JHEP reports : innovation in hepatology 2021; (3(4)):100305 doi:10.1016/j.jhepr.2021.100305.

    PMID: 34189448
  8. 8

    Contemporary epidemiology of hepatocellular carcinoma: understanding risk factors and surveillance strategies.

    Jaber F, Cholankeril G, El-Serag HB

    Journal of the Canadian Association of Gastroenterology 2024; (7(5)):331-345 doi:10.1093/jcag/gwae025.

    PMID: 40786815
  9. 9

    The Changing Demographics and Epidemiology of Hepatocellular Carcinoma.

    Gujarathi R, Klein JA, Liao CY, Pillai A

    Clinics in liver disease 2025; (29(1)):1-15 doi:10.1016/j.cld.2024.08.001.

    PMID: 39608950
  10. 10

    Changing etiology and epidemiology of hepatocellular carcinoma: Asia and worldwide.

    Kim DY

    Journal of liver cancer 2024; (24(1)):62-70 doi:10.17998/jlc.2024.03.13.

    PMID: 38523466
  11. 11

    Epidemiology and Management of Hepatocellular Carcinoma.

    Kulik L, El-Serag HB

    Gastroenterology 2019; (156(2)):477-491.e1 doi:10.1053/j.gastro.2018.08.065.

    PMID: 30367835
  12. 12

    Models estimating risk of hepatocellular carcinoma in patients with alcohol or NAFLD-related cirrhosis for risk stratification.

    Ioannou GN, Green P, Kerr KF, Berry K

    Journal of hepatology 2019; (71(3)):523-533 doi:10.1016/j.jhep.2019.05.008.

    PMID: 31145929
  13. 13

    A Rare Case of Hepatocellular Carcinoma Presenting as Cervical Lymph Node Metastases and Review of the Literature.

    Tkachuk B, Stukalin I, Wang Y, Congly SE

    ACG case reports journal 2025; (12(2)):e01620 doi:10.14309/crj.0000000000001620.

    PMID: 39911373
  14. 14

    Systematic review with meta-analysis: risk of hepatocellular carcinoma in non-alcoholic steatohepatitis without cirrhosis compared to other liver diseases.

    Stine JG, Wentworth BJ, Zimmet A, et al.

    Alimentary pharmacology & therapeutics 2018; (48(7)):696-703 doi:10.1111/apt.14937.

    PMID: 30136293
  15. 15

    Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival Among Patients with Cirrhosis in the US.

    Singal AG, Mittal S, Yerokun OA, et al.

    The American journal of medicine 2017; (130(9)):1099-1106.e1 doi:10.1016/j.amjmed.2017.01.021.

    PMID: 28213044
  16. 16

    Hepatocellular and extrahepatic cancer risk in people with non-alcoholic fatty liver disease.

    Thomas JA, Kendall BJ, El-Serag HB, et al.

    The lancet. Gastroenterology & hepatology 2024; (9(2)):159-169 doi:10.1016/S2468-1253(23)00275-3.

    PMID: 38215780
  17. 17

    Factors That Predict the Progression of Non-alcoholic Fatty Liver Disease (NAFLD).

    Parameswaran M, Hasan HA, Sadeque J, et al.

    Cureus 2021; (13(12)):e20776 doi:10.7759/cureus.20776.

    PMID: 35111461
  18. 18

    Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma.

    Finn RS, Qin S, Ikeda M, et al.

    The New England journal of medicine 2020; (382(20)):1894-1905 doi:10.1056/NEJMoa1915745.

    PMID: 32402160

This overview of hepatocellular carcinoma is for informational purposes only and does not replace professional medical advice. Always discuss your specific HCC diagnosis, staging, and treatment plan with your hepatologist or oncologist.

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