Hepatocellular Carcinoma (HCC)
Key points
- Hepatocellular Carcinoma (HCC) is a type of liver cancer
- It can be cured if you find it at a very early stage
- There is an effective treatment for almost all stages of HCC
- If you already have liver damage or cirrhosis you should have regular screening for HCC. This is also called surveillance. Talk to your GP or liver specialist
- Some people die of HCC, particularly if it is not found at an early stage
Transcript
I’m pretty much on my last legs, there’s no doubt about that whatsoever. But I’ve got way too much going on in my life, I’m too busy to die.
I was born and bred on the North Shore, the northern beaches of Sydney. I’m an old surfer from way back. I came to the country to do agricultural science and I stayed here. My wife and I, we love it here where we are in the Riverina of New South Wales. And we grow beef cattle and we enjoy raising calves and we love living on our property. It’s a great life.
Just started getting tired during the day. I’d always done early starts and longish days and it was noticeably dragging me down. And so I went to my GP and he just started doing blood tests, you know. And the blood tests came back that, Don, you’ve got Hep C. And I’d had it a long time and significant and substantial liver damage had already been done. And I was starting to feel the effects of that.
So I saw a very, very good gastroenterologist in Wagga. Yeah, this was, as it turned out, primary liver cancer, hepatocellular carcinoma. And I had some real problems and it was only going to get worse.
As far as I was concerned after being told you’ve got primary liver cancer, well, it’s fight. The glass is half full. It’s not half empty, it’s half full. So go home, do as you’re told. Rely on the medical professionals and the medical science. And yeah, it was downhill, don’t worry about that. But trust in what you’re being told and go and do as you’re told.
I’m pretty much on my last legs. My mobile rings about 10 o’clock at night. And I thought, who’s ringing me? But I answered it, even though I couldn’t be bothered doing anything. And it was very simply, ‘Is that Don?’
‘Yep.’
‘Don, it’s Mike from RPA.’
‘Hello, Mike.’
‘Don, you need to get to Sydney by 6am.’ I said, ‘We can do that.’
I went in, had my operation about midday. I still remember the clock in the theatre. And woke up in intensive care next day at 10am on a Saturday morning. I knew straight away that I was better. I’d gone from one day not being able to eat, not being able to talk, not really being able to do anything, because you’re so physically shot to pieces by that stage your body’s had it.
All of a sudden, wanting to eat, wanting to talk, having depth in your voice. It’s just marvellous where science has got me.
I don’t sit here doing this little interview unless there was a liver donor. It’s as simple as that. Yes, it’s tough to get your head around. But I think Australians in general are reasonably pragmatic about life and death. And I think that the idea of organ donation, which saved my life, is something that we just have to normalise around the dining table from a young age for children, just within the family environment, so that the idea of organ donation and registering to be an organ donor is just something you go and do, because it can change lives.
And the key for me was, at my age, at that age I was 57, I felt that if I died, and I was going to very soon, that I’d have let the family down, because I felt I was still way too young.
Transcript
HCC stands for hepatocellular carcinoma. Now that’s a big word or big group of words and it’s a form of primary liver cancer. So it’s a cancer that starts in the liver, and in the vast majority of people it starts in a liver that’s already been damaged by other causes and that could be due to hepatitis such as hepatitis C or hepatitis B, could be due to alcohol, could be due to fatty liver disease, could be due to autoimmune liver diseases and a range of other rarer liver diseases.
But in 90% of people there is other underlying liver disease. So we know these people are at risk and then they can develop primary liver cancer or HCC.
The question is, will people know when they develop HCC? Now we would actually prefer that we find HCC on surveillance because that means we’re finding early-stage HCC. That means that we can deliver curative treatment. If we’re waiting for symptoms to develop then we’re probably too late.
Symptoms
But the symptoms only develop when there’s a very large tumour or where there’s complications such as the tumour’s ruptured or it’s invaded into a vein, or it’s spread outside of the liver. So that’s way too late to expect us to be able to cure it.
So in fact for the vast majority of people there are no symptoms of HCC because we’re detecting it on surveillance.
Risk factors
Because most people don’t have symptoms of early HCC, and that’s when they’ve got a very small tumour such as just a one- or two-centimetre tumour, then we have to know who’s at risk. And that means anybody who has liver disease due to fatty liver or because they drink too much or because they have hepatitis or because they’ve got other cause of liver disease need to know when their liver disease has progressed to the stage where they’ve got scarring to the point of cirrhosis, where surveillance would be recommended.
And that’s really up to your GP or your specialist to do evaluations and tell you that they think cirrhosis has actually developed and therefore you’re at increased risk.
Do I need surveillance?
So people want to know whether they’re at risk of HCC and we know the people who are at risk of HCC fall into two main camps. One is people who have cirrhosis, and that means really severe scarring of the liver where the liver is very nodular or knobbly and there’s downstream consequences of that.
The other group of people who are at risk are people living with chronic hepatitis B and there is some age cutoffs where we do recommend surveillance according to where people were born and how long they’re likely to have had their hepatitis B infection.
What is surveillance?
So what does having surveillance for liver cancer look like? Well, it’s an ultrasound every six months combined with the blood test. What we’re looking for is an early cancer.
So we’re looking for a new little lump that’s evolved in the liver that may be only one or two centimetres in size and maybe wasn’t there last time you had the ultrasound.
Now when we find that, that doesn’t mean you’ve got liver cancer. It means that another test has to be done to characterise or to really show the features of that lump that’s evolved in the liver and tell us whether it is likely to be a liver cancer. So for most people that will be a CT scan with contrast or an MRI scan with contrast. And then in most cases we can make a more definitive diagnosis of HCC based on that scan.
Go every 6 months
So if people are at risk of HCC, it is a good idea to have that six-monthly ultrasound. Now what if you leave it to 12 months, 18 months, two years? Well, the risk is that by the time we find the cancer it’s no longer going to be curable because it will have grown bigger.
So it’s been decided by various studies that six months is the optimal time to find a small cancer that maybe wasn’t there last time, but it’s still in a stage where it might be able to be cured.
What next?
Once an ultrasound found that little lump and there’s been another scan such as a CT scan or an MRI scan and it really does look like it’s a liver cancer, for most people they’ll be referred to a multidisciplinary team that runs in a major hospital with a big liver unit. And that’s across the country, and even if people are living in regional or remote locations, their case can be referred into a multidisciplinary team in a major centre.
Now at that team meeting there’ll be radiologists, there’ll be liver specialists, there be cancer specialists, there’ll be surgeons, there’ll be nurses, and lots of expertise to really have a look at the scan and look at your features and what you’re like and where you are about what’s the best treatment for you.
What next?
So if you have risk factors for liver disease, you’ve ever been exposed to hepatitis or you’ve got a family history of hepatitis, you’re living with overweight or obesity, or you have diabetes, or you’re drinking too much alcohol beyond the recommended limits, you may have liver disease.
It’s suggested you go and see your GP and be assessed for liver disease with a blood test, with an ultrasound and with a history taken about your risk factors.
If you’ve got risk factors for liver disease, they can be treated to reduce your risk of getting liver cancer.
What is HCC?
Hepatocellular carcinoma (HCC) is a cancer that starts in the liver. This is called ‘primary liver cancer’. Other types of liver cancer have usually spread to the liver from somewhere else in the body, such as the colon, lung or breast.
HCC affects the main type of liver cells, called hepatocytes. The cells start to mutate and divide out of control. The cancer grows as lumps (tumours) throughout the liver and can eventually spread to other parts of the body.
HCC is the most common type of primary liver cancer. It’s become much more common over the last 40 years. In Australia, around 3,000 people are diagnosed with HCC every year and the rates are increasing. The highest rates are in people aged 60 to 64. It occurs more often in men than in women.
Despite improvements in treatment, because it is often diagnosed late, only 1 in 5 people diagnosed with HCC will survive more than 5 years. Liver cancer is the seventh most common cause of cancer death in Australia.
The earlier you find out you have HCC, the better the chance of having a treatment that can cure it.
What are the symptoms of HCC?
Like other liver cancers, HCC doesn’t usually cause any symptoms in the early stages. When symptoms do eventually appear it usually means the cancer is in an advanced stage. These symptoms may include:
- Unexpected weight loss
- Losing your appetite
- Pain in the upper right of the trunk or in the right shoulder
- Feeling sick and vomiting
- Feeling tired and weak
- Swollen belly
- Yellow eyes and skin (jaundice)
- Pale poos
- Dark urine (wee)
Do I need to screen for liver cancer?
Some people are more at risk of developing HCC. It’s recommended that you have an ultrasound and possibly a blood test to check for HCC every 6 months if:
- You have cirrhosis or have ever been diagnosed with cirrhosis
- You have long standing hepatitis B infection and:
-You are a man of Asian heritage over 40 years or a woman of Asian heritage over 50 years
-You are of African heritage and aged over 20 years
-You are of Aboriginal and Torres Strait Islander heritage and aged 50 years
-You have a family history of liver cancer.
How is HCC diagnosed?
Liver ultrasound is the main way doctors find HCC. If you have problems with your liver, you are likely to have regular ultrasounds to check for HCC.
Sometimes your doctor will combine the ultrasound with a blood test. This is to look for levels of alpha-fetoprotein (AFP), a protein that is produced by HCC tumours. AFP levels can be normal even if you have HCC.
A diagnosis of HCC can’t be made from an ultrasound. If an abnormal lump is found, your doctor will then order a CT or an MRI scan to make a diagnosis of HCC.
Sometimes, it’s necessary to look at a small sample of liver tissue taken in a biopsy to confirm the cancer.
Once HCC is confirmed, you may need further tests to work out the stage of the cancer. That means, how far it has spread.
The most common way of staging HCC in Australia is the Barcelona Clinic Liver Cancer (BCLC) staging system:
- Stage 0: Very early stage. There is just one lump in the liver that’s less than 2 cm in diameter
- Stage A: Early stage. There is one lump more than 2 cm or 2 to 3 lumps each less than 3 cm
- Stage B: Intermediate stage. There are more than 3 lumps or 2 to 3 lumps with at least one being bigger than 3 cm
- Stage C: Advanced stage. The cancer has spread into the veins or to other parts of the body
- Stage D: Terminal stage with liver failure
Why did I get HCC?
The risk of developing HCC is higher in people who have long-term liver disease of any cause that has progressed to cirrhosis.
Some people with long standing hepatitis B are at increased risk of developing HCC.
Smoking, drinking unhealthy amounts of alcohol, or having diabetes or obesity increase the chance of developing HCC.
Sometimes, people with no history of liver disease can get an HCC.
How is HCC treated?
The treatment for HCC depends on how far it has spread. It is recommended that the treatment options for someone with HCC should be discussed by a multidisciplinary team – a team of doctors, nurses and other allied health professionals with different areas of expertise.
Your doctor or liver cancer nurse will talk to you to discuss which treatment is best for you. They will give you information about the treatment. All treatments have a risk of complications or side effects and it is important to discuss these with your healthcare team.
Surgery
Surgery is sometimes recommended to remove the tumour and some of the healthy tissue around it. This surgery is suitable if the tumour has not spread outside the liver and it can be completely removed, leaving enough liver for you to live with.
To decide whether surgery is for you, your doctor will look at the stage of the HCC, your overall health and your liver function.
After surgery, there is a risk of liver failure, complications of surgery or the HCC coming back.
For some people, a liver transplant may give the best chance of cure. This is only an option for people who have early-stage liver cancer. A liver transplant completely removes the HCC along with the liver disease. There is a very good survival rate for people who have liver transplants in Australia.
Radiology-guided therapy
Most people with HCC aren’t suited to surgery or a liver transplant because of their underlying liver disease, age or other medical conditions.
In this case, your doctor may refer you to a doctor called an interventional radiologist for radiology-guided therapy. This is a treatment directed straight to the cancer in the liver. The rest of the body is not affected by the treatment and there is less chance of side effects.
Radiology-guided therapies may completely cure small cancers, or shrink and control larger tumours. They include:
- Ablation – using an ultrasound as a guide, the doctor inserts one or more thin needles through your belly into the liver. When the needles reach the tumour, they are heated with an electric current or microwaves to destroy the cancer cells.
- Chemical injection – ethanol is injected into the tumour to kill the cancer cells.
- Transarterial chemoembolisation (TACE) – chemotherapy (drugs that destroy cells) is injected into arteries that supply blood to the tumour.
- Radioembolisation or Selective internal radiation therapy (SIRT) – tiny beads are inserted into the tumour through the arteries that supply blood to the tumour to provide high doses of internal radiation.
Radiation therapy
Radiation therapy is when energy from X-rays is targeted at the cancer to kill the cells. It is sometimes used in HCC if other treatments aren’t possible or haven’t worked. In people with advanced HCC, radiation can shrink the tumour and relieve some of the symptoms.
Drug therapies
Some patients are suitable to receive drugs therapies that can treat cancer cells wherever they may be in the body. The most commonly used drugs in Australia for HCC are:
- a form of immunotherapy given by infusion into a vein every 3 weeks that helps the body’s immune system fight tumours, or
- a targeted therapy taken as tablets by mouth.
If these drugs don’t work, you doctor will discuss possible second-line treatments.
There’s a lot of research at the moment into new medications that are showing promise to treat HCC and it is likely that treatments will change over time.
Palliative care
Palliative care is care that aims to help with symptoms and let you live your best life possible. It does not mean end-of-life care. People can have palliative care at any stage of their cancer.
Palliative treatments may include radiation therapy or using drugs to manage symptoms.
Your doctor may refer you to a palliative care team to help manage your symptoms and maintain your quality of life.
Read more about liver treatmentsLiving with HCC
If you are diagnosed with HCC, there are some important things you can do to make sure you’re as healthy as you can be.
HCC stops the liver from working properly, so the body uses up fat and muscle to provide energy. This can lead to muscle wasting, weight loss and loss of strength.
If you have HCC, you may need to eat more kilojoules and more protein than you did previously. It’s a good idea to talk to an accredited dietitian about a high protein, high energy eating plan. You can eat small meals often, have extra energy-rich snacks, and avoid salt. You can read more about an eating plan here.
There are other ways you can live well with HCC.
- Look after your overall health by exercising.
- If you are overweight, try to lose weight.
- Avoid all alcohol to protect your liver.
- Avoid anything that is toxic to your liver, including some medications, alternative medicines and liver tonics.
- Look after any other health conditions you may have, such as diabetes.
- Give up smoking if you are a smoker.
- Get support for your mental health if you need it.
- Tell your doctor if symptoms are bothering you, as there are many ways to relieve them.
Additional information and support
- Cancer Council 13 11 20
- Understanding Liver Cancer (Cancer Council, PDF booklet)
- Liver Cancer: Your guide to best cancer care (Cancer Australia and Cancer Council booklet)
What next?
Read more about living wellReferences
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Reviewed May 2025