Liver Cancer from Detection to Treatment


What is Liver Cancer?

Liver cancer is a type of cancer that starts in the cells of the liver, the organ responsible for filtering blood, processing nutrients, and breaking down toxins.

The most common type is hepatocellular carcinoma, which begins in the main liver cells called hepatocytes.

Other, less common types include intrahepatic cholangiocarcinoma | bile duct cancer | and angiosarcoma of the liver.


1. Initial Detection / Screening
Liver cancer - most commonly hepatocellular carcinoma often develops in people with chronic liver disease.

High-Risk Group Screening:

Regular screening every 6 months for people with
Chronic hepatitis B or C
Liver cirrhosis
Family history of liver cancer

Screening tests:
Ultrasound - main screening tool
Alpha-fetoprotein blood test – tumor marker

Symptoms:
Abdominal pain or swelling
Weight loss, loss of appetite
Jaundice
Fatigue
Nausea or vomiting


2. Diagnostic Testing

Imaging
Multiphasic CT scan or MRI
Contrast-enhanced ultrasound
PET-CT

Blood Tests
Alpha-fetoprotein
Liver function tests
Viral hepatitis panel

Biopsy
Fine-needle aspiration
Core biopsy under ultrasound/CT guidance


3. Staging
Staging shows how far the cancer has spread.

Common Staging Systems

Barcelona Clinic Liver Cancer system - widely used; includes
Stage 0 (very early)
Stage A (early)
Stage B (intermediate)
Stage C (advanced)
Stage D (end-stage)

TNM system
based on tumor size, nodes, metastasis.

Child-Pugh score
assesses liver function.

Imaging for Staging:
CT/MRI chest and abdomen
Bone scan


4. Treatment Options

Curative Options (Early Stages)

Surgical Resection
Liver Transplantation
Local Ablation
Radiofrequency ablation
Ethanol injection

Palliative / Non-Curative Options (Intermediate to Advanced)

Transarterial Chemoembolization
Transarterial Radioembolization
Systemic Therapy

Targeted therapy:
Sorafenib, lenvatinib (first-line).
Regorafenib, cabozantinib, ramucirumab (second-line).

Immunotherapy:
Atezolizumab + bevacizumab.
Pembrolizumab, nivolumab for selected patients.

Radiation Therapy

Stereotactic body radiotherapy


5. Palliative & Supportive Care

Pain management, ascites control (fluid removal or diuretics).
Nutritional support for patients with advanced cirrhosis.
Psychological and family support.


6. Follow-Up and Monitoring

Imaging (CT/MRI) every 3–6 months for recurrence.

AFP blood test every 3–6 months.

Monitor liver function and viral load

Lifestyle changes:
Maintain healthy weight
Manage hepatitis