What the diagnosis means
Most primary liver cancers are hepatocellular carcinoma (HCC); a smaller number are bile-duct cancers (cholangiocarcinoma), which are treated differently. Cancer that has spread to the liver from elsewhere (for example from the bowel) is not liver cancer and is treated according to where it started.
Because HCC almost always develops in a damaged liver, two things are staged at once: the tumour (size, number, blood-vessel involvement, spread) and the liver's reserve (Child-Pugh score, bilirubin, albumin, clotting, presence of fluid or portal hypertension). Diagnosis is sometimes made on characteristic scans without a biopsy.
Where medical oncology fits
Liver cancer care is shared between hepatologists, liver surgeons and transplant teams, interventional radiologists and medical oncologists:
- Early disease in a well-functioning liver: surgical removal, transplant in selected patients, or ablation (heat treatment through the skin).
- Intermediate disease: liver-directed treatments such as TACE (chemo-embolisation) delivered by interventional radiology.
- Advanced disease, or disease that has progressed after local treatment: systemic therapy led by medical oncology — currently immunotherapy-based combinations or targeted tablets, chosen according to liver function, bleeding risk and other illnesses.
Controlling the underlying cause — antiviral treatment for hepatitis B or C, stopping alcohol — is part of treatment, not separate from it.
What to expect
Systemic therapy is given as infusions every three weeks or as daily tablets, with blood tests to watch liver function closely. Side effects can include tiredness, raised blood pressure, hand-foot skin reaction, diarrhoea, and immune-related effects with immunotherapy; bleeding risk from varices is assessed before some drugs are started. Scans every 2–3 months and the AFP blood marker help track response.
Questions to ask
- How healthy is my liver, and how does that limit or shape the options?
- Am I a candidate for surgery, transplant or ablation — now or after other treatment?
- Is TACE or another liver-directed treatment appropriate before systemic therapy?
- Which systemic option fits my liver function and bleeding risk?
- What treatment do I need for hepatitis or alcohol-related liver disease alongside the cancer treatment?
Preparing for your consultation
Bring triple-phase CT or MRI of the liver with reports, liver function tests, hepatitis B/C results, AFP, any endoscopy report (varices), previous treatment details, and a list of medicines. Note any history of jaundice, abdominal swelling or bleeding.