When is hepatocellular carcinoma considered advanced?

Liver cancer is a group of cancers that originate in the liver. The most common type of liver cancer is called hepatocellular carcinoma (HCC). This type accounts for approximately 80 to 90 percent of cases of liver cancers. HCC originates in liver cells called hepatocytes.

Hepatocytes play a direct role in many of the hundreds of functions performed by the liver, including secreting bile, storing and metabolizing vitamins, metabolizing drugs, and synthesizing blood components like plasma proteins and clotting factors.

HCC begins when hepatocytes undergo genetic damage or genetic changes (mutations), creating cancerous cells. These cancerous cells grow and divide in an uncontrolled way. As cancer cells increase in number, they can form tumors, tumors can invade nearby tissues, and cancer can spread to other areas of the body.

Early-stage liver cancer

Liver cancers like HCC are staged based on the size of the tumor, if it has spread to nearby lymph nodes, and if it has metastasized to other parts of the body. Staging will take into account a number of specific variables, and a healthcare provider will always be your best source of information about a diagnosis.

In simple terms, liver cancer is considered early stage when the tumor is resectable. This means it can potentially be removed by surgery. In some cases, a person may have the entire liver removed and receive a transplant.

A small percentage of individuals who are diagnosed with liver cancer are eligible for surgery as the primary treatment. It is more common for liver cancers like HCC to be diagnosed after the cancer has advanced beyond the early stage and cannot be removed with surgery.

In the early stages, liver cancer can cause few or no symptoms. It also most commonly occurs in people who already have a form of liver disease, such as a chronic hepatitis infection or metabolic dysfunction-associated steatotic liver disease (MASLD). Consequently, a person may not know they have cancer, or they may have symptoms that can be attributed to an existing diagnosis of liver disease.

Anyone with a form of liver disease should speak to a healthcare provider about screening for liver cancer.

Unresectable liver cancer

Cancer that cannot be removed with surgery is described as unresectable.

Locally advanced

Unresectable liver cancer includes situations where the tumor is too large to be removed, where there are multiple tumors, or where a tumor is located too close to a major blood vessel. These situations are sometimes described as locally advanced, because while the cancer has advanced beyond the early stage, it is still confined to the liver or the area around the liver.

Treatment for locally advanced liver cancers often includes therapies that aim to destroy or shrink the tumors in the liver. This can include radiation therapy, sealing off blood vessels that supply the tumor (embolization), cancer drugs infused directly into the tumor, or ablation. Ablation refers to therapies that destroy tumors without surgery, using a variety of methods such as energy waves, freezing, sound waves, and injections of ethanol.

Treatment for locally advanced cancers can also include systemic therapies, cancer drugs that travel through the bloodstream and act on cancer cells throughout the body.

Sometimes, treatment may shrink a tumor enough that it can be removed by surgery.

Advanced liver cancer

Liver cancer is considered advanced when it has spread to nearby lymph nodes or metastasized to other parts of the body.

Treatment for advanced liver cancer will depend on the health of the liver. If the liver is healthy enough, the cancer is often treated with a combination of immunotherapy and/or targeted therapy drugs. Chemotherapy is sometimes used if other treatments are ineffective.

Immunotherapies are cancer drugs that help the body’s immune system recognize and attack cancer cells. Targeted therapy drugs act on specific molecules that cancer cells need to survive and grow.

Clinical trials may also be an option for both locally advanced and advanced liver cancers.

For information about a diagnosis and treatment, a healthcare provider will be your best source of information. When discussing any treatment for liver cancer, it is important to discuss the health of your liver and the potential side effects of that treatment.